Representative Payee Report of Benefits and Dedicated Account

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-6233 Representative Payee Report of Benefits and Dedicated Account	Form and Instruction	Modified	Available
0576 addendum.doc	Supplementary Document	Uploaded 2009-11-19	Available
Supporting Statement-0576 revised.doc	Supporting Statement A	Uploaded 2009-11-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9534	Representative Payee Report of Benefits and Dedicated Account, 20 CFR 416.546 & 640, and 20 CFR 416.635 & 665	Form and Instruction	Modified	Representative Payee Report of Benefits and Dedicated Account

ICR Details

OMB Control No: 0960-0576	ICR Reference No: 200908-0960-007
Status: Historical Active	Previous ICR Reference No: 200611-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Representative Payee Report of Benefits and Dedicated Account
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: 02/24/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/19/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2013	36 Months From Approved	03/31/2010
Responses	30,000	0	30,000
Time Burden (Hours)	10,000	0	10,000
Cost Burden (Dollars)	0	0	0

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Abstract: 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.

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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:
	74 FR 44508	09/02/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 59336	11/17/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Representative Payee Report of Benefits and Dedicated Account, 20 CFR 416.546 & 640, and 20 CFR 416.635 & 665	SSA-6233	Representative Payee Report of Benefits and Dedicated Account

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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	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

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $231,000

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)? No

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: 11/19/2009

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