Information Collection

Representative Payee Evaluation Report--State/Local Government

IC 181091 under ICR 201004-0960-007 · OMB 0960-0069.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0069 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-624 Representative Payee Evaluation Report--State/Local Government Form
SSA-624 Representative Payee Evaluation Report SSA-624-F5.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Representative Payee Evaluation Report--State/Local Government	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 416.665 20 CFR 404.2062

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-624	Representative Payee Evaluation Report	SSA-624-F5.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: 8,410	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	8,410	510	7,900
Annual IC Time Burden (Hours)	4,205	255	3,950
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.