Representative Payee Evaluation Report

Forms and Documents

Document	Type	Status	Availability
Form SSA-624 Representative Payee Evaluation Report--Individuals/Households	Form	Modified	Available
Form SSA-624 Representative Payee Evaluation Report--Private Sector	Form	New	Available
Form SSA-624 Representative Payee Evaluation Report--State/Local Government	Form	New	Repair queued
Charts Showing the Program Change for the SSA-624 (0960-0069).doc	Supplementary Document	Uploaded 2007-07-10	Available
Supporting Statement--0069.doc	Supporting Statement A	Uploaded 2007-08-10	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
9009	Representative Payee Evaluation Report--Individuals/Households	Form	Modified
181092	Representative Payee Evaluation Report--Private Sector	Form	New
181091	Representative Payee Evaluation Report--State/Local Government	Form	New

ICR Details

OMB Control No: 0960-0069	ICR Reference No: 200707-0960-001
Status: Historical Active	Previous ICR Reference No: 200408-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Representative Payee Evaluation Report
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/07/2007
	Date Received in OIRA: 08/23/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2010	36 Months From Approved	11/30/2007
Responses	250,000	0	252,000
Time Burden (Hours)	125,000	0	126,000
Cost Burden (Dollars)	0	0	0

---

Abstract: Sections 205(j) and 1631(a)(2) of the Social Security Act provide that a representative payee may be appointed to receive benefits on behalf of an individual entitled to Title II and/or Title XVI benefits when that individual is unable to manage or direct the management of those funds him/herself. The representative payee is required to report to SSA at least once per year on how those funds received have been used or conserved. When a representative payee fails to adequately report to SSA as required, SSA will conduct a face-to-face interview with the payee to complete an SSA-624, Representative Payee Evaluation Report, in order to determine the continued suitability of the representative payee to serve as a payee. The respondents are individuals and organizations who act as representative payees for Title II and Title XVI benefits who fail to comply with SSA’s statutory annual reporting requirement.

---

Authorizing Statute(s): US Code: 42 USC 405 Name of Law: null
   US Code: 42 USC 1383 Name of Law: null
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 26443	05/09/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 44211	08/07/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Representative Payee Evaluation Report--Individuals/Households	SSA-624	Representative Payee Evaluation Report
Representative Payee Evaluation Report--Private Sector	SSA-624	Representative Payee Evaluation Report
Representative Payee Evaluation Report--State/Local Government	SSA-624	Representative Payee Evaluation Report

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	250,000	252,000	0	-360	-1,640	0
Annual Time Burden (Hours)	125,000	126,000	0	-180	-820	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: The decrease in the public reporting burden is due to the replacement of the SSA-624 with the SSA-639 for the 2000 random interviews which are conducted annually. The increases shown are due to the addition of the two ICs which were necessary in order to show the burden per type of respondent (Individuals, Businesses, and Local/State Government). Before ROCIS we did not have the ability to split the burden amongst these three types of respondents and, therefore, only reported one burden. Now that we have the ability to show the burden in this way, we have done so in ROCIS. Also, please note that in the two new ICs SSA was unable to accurately make the numbers for the program change negative and still show the correct amounts in the Change Due to Agency Discretion column (see the charts which show this change in the Supplementary Documents section). Please consider revising the ROCIS system to accommodate a fix for this issue.

---

Annual Cost to Federal Government: $1,164,240

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/23/2007

---