Representative Payee Report (Adult Beneficiaries)

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⚠️ Notice: This information collection may be referencing outdated material.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-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

Information Collection (IC) Details

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:

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 %

	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

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.