Representative Payee Report (Adult, Child, and Organizational Representative Payee)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-623 Representative Payee Report (Adult)	Form and Instruction	Modified	Available
Form SSA-6234 Representative Payee Report (Organization)	Form and Instruction	New	Available
Form SSA-6230 Representative Payee Report (Child)	Form and Instruction	New	Available
0960-0068 supporting statement (2008).doc	Supporting Statement A	Uploaded 2008-07-30	Available
0960-0068 addendum.doc	Supplementary Document	Uploaded 2008-07-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9006	Representative Payee Report (Adult Beneficiaries)	Form and Instruction	Modified	Representative Payee Report (Adult)
9006	Representative Payee Report (Adult Beneficiaries)	Instruction	Modified
185842	Internet Representative Payee Report (iRPA)	Other-Online application	New
185841	Representative Payee Report (Organization)	Instruction	New
185841	Representative Payee Report (Organization)	Form and Instruction	New	Representative Payee Report (Organization)
185840	Representative Payee Report (Child Beneficiaries)	Instruction	New
185840	Representative Payee Report (Child Beneficiaries)	Form and Instruction	New	Representative Payee Report (Child)

ICR Details

OMB Control No: 0960-0068	ICR Reference No: 200807-0960-006
Status: Historical Active	Previous ICR Reference No: 200701-0960-013
Agency/Subagency: SSA	Agency Tracking No:
Title: Representative Payee Report (Adult, Child, and Organizational Representative Payee)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/03/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/31/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2011	36 Months From Approved	03/31/2010
Responses	6,250,000	0	5,500,000
Time Burden (Hours)	1,562,500	0	1,375,000
Cost Burden (Dollars)	0	0	0

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Abstract: When SSA determines it is not in beneficiaries’ best interests to receive their Social Security benefits payments directly, the Agency will designate a family member, unrelated person, or organization to act as the representative payee for such beneficiaries. Representative payees must account to SSA about how they use these payments on their beneficiaries’ behalf; they use forms SSA-623 (for adult beneficiaries), SSA-6230 (for child beneficiaries), and SSA-6234 (organizational rep payees) to do so. This ICR is for three changes to the collection: 1) we are clearing an Internet version of the Representative Payee Report, 2) we are combining all three paper forms under one OMB number, 0960-0068, and 3) we are making minor formatting changes to the first page of the paper forms' instructions.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 22989	04/28/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 37524	07/01/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Internet Representative Payee Report (iRPA)
Representative Payee Report (Adult Beneficiaries)	SSA-623	Representative Payee Report (Adult)
Representative Payee Report (Child Beneficiaries)	SSA-6230	Representative Payee Report (Child)
Representative Payee Report (Organization)	SSA-6234	Representative Payee Report (Organization)

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ICR Summary of Burden

table that charts list 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	6,250,000	5,500,000	0	750,000	0	0
Annual Time Burden (Hours)	1,562,500	1,375,000	0	187,500	0	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: Miscellaneous Actions

Short Statement: The increase in burden is due to our folding in form SSA-6234 into this OMB number. Please note there was no actual burden reduction. There appeared to be one because of the way ROCIS had mistakenly combined two separate forms under one IC.

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Annual Cost to Federal Government: $29,500,000

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

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Common Form ICR:  No

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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: 07/31/2008

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