Representative Payee Report of Benefits and Dedicated Account

ICR 200908-0960-007

OMB: 0960-0576

Federal Form Document

Forms and Documents
ICR Details
0960-0576 200908-0960-007
Historical Active 200611-0960-005
Representative Payee Report of Benefits and Dedicated Account
Revision of a currently approved collection   No
Approved without change 02/24/2010
Retrieve Notice of Action (NOA) 11/19/2009
  Inventory as of this Action Requested Previously Approved
02/28/2013 36 Months From Approved 03/31/2010
30,000 0 30,000
10,000 0 10,000
0 0 0

Federal regulations provide for representative payees (RPs) to submit a written report accounting for the use of money paid to Supplemental Security Income (SSI) beneficiaries, and that RPs must establish and maintain a dedicated account for these payments. The SSA-6233 is used to ensure that the RP is using the benefits received for the beneficiary's current maintenance and personal needs, and the expenditures of funds from the dedicated account are in compliance with the law. Respondents are representative payees for SSI beneficiaries.

US Code: 42 USC 1383 Name of Law: Social Security Act

Not associated with rulemaking

  74 FR 44508 09/02/2009
74 FR 59336 11/17/2009

  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 30,000 30,000 0 0 0 0
Annual Time Burden (Hours) 10,000 10,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0

Elizabeth Davidson 411-965-0454 [email protected]


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:
    (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;
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.

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