Representative Payee Report (Organization)

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0068 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-6234 Representative Payee Report (Organization) Form and Instruction
Form SSA-6234 -- revised 1st-page instructions.doc Instruction
Rep Payee Insert.pdf Other-Information Insert for Paper F
SSA-6234 Representative Payee Report (Organization) Form SSA-6234.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Representative Payee Report (Organization)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.2065 20 CFR 404.635 20 CFR 416.665 20 CFR 404.2035

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	SSA-6234	Representative Payee Report (Organization)	Form SSA-6234.pdf	No	Paper Only
Instruction			Form SSA-6234 -- revised 1st-page instructions.doc	No	Paper Only
Other-Information Insert for Paper Forms Re New Internet Option			Rep Payee Insert.pdf	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 626,875	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	626,875	626,875
Annual IC Time Burden (Hours)	156,719	156,719
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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