Information Collection

Representative Payee Report (Adult Beneficiaries)

IC 9006 under ICR 200807-0960-006 · OMB 0960-0068.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-623 -- revised 1st-page instructions.doc	Instruction
Rep Payee Insert.pdf	Other-Informational Insert Re New On
SSA-623 Representative Payee Report (Adult) Form SSA-623.pdf	Form and Instruction

IC Title:

Representative Payee Report (Adult Beneficiaries)

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 416.665 20 CFR 404.635 20 CFR 404.2035 20 CFR 404.2065

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Instruction			Form SSA-623 -- revised 1st-page instructions.doc	No	Paper Only
Other-Informational Insert Re New Online Option			Rep Payee Insert.pdf	No	Paper Only
Form and Instruction	SSA-623	Representative Payee Report (Adult)	Form SSA-623.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: 2,093,125

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,093,125	-3,406,875	5,500,000
Annual IC Time Burden (Hours)	523,281	-851,719	1,375,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.