Application for Substitution of Payee and Duties As Representative Payee (Individuals)

Application to Act as Representative Payee

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0052 can be found here:

Documents and Forms

Document Name Document Type
Form AA-5 Application for Substitution of Payee and Duties As Representative Payee (Individuals) Form
AA-5 Application for Substitution of Payee Form AA-5 (01-04).pdf Form
RB-5 RB-5 Booklet; Your Duties as Representative Payee- Repre Form RB-5 (3-98).pdf Form and Instruction
Form SSA-11-BK (03-2006).pdf SSA-11-BK (3-2006) IC Document

Information Collection (IC) Details

IC Title:	Application for Substitution of Payee and Duties As Representative Payee (Individuals)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 266.9 20 CFR 266.7 20 CFR 266.6

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AA-5	Application for Substitution of Payee	Form AA-5 (01-04).pdf		No		Paper Only
Form and Instruction	RB-5	RB-5 Booklet; Your Duties as Representative Payee- Representative Payee's Record	Form RB-5 (3-98).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: RRB 22 - Railroad Retirement, Survivor, and Pensioner Benefit System	FR Citation: 40 FR 36268

Number of Respondents: 11,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	13,725	-6,575	20,300
Annual IC Time Burden (Hours)	12,112	-4,238	16,350
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-11-BK (3-2006)	Form SSA-11-BK (03-2006).pdf	03/01/2006

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.