Information Collection

Representative Payee Monitoring

IC 33950 under ICR 201101-3220-001 · OMB 3220-0151.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0151 can be found here:

Documents and Forms

Document Name Document Type
Form G-99A (04-07) Representative Payee Monitoring Form
G-99A (04-07) Representative Payee Report Form G-99A (04-07).pdf Form
G-99C (01-09) Representative Payee Evaluation Report Form G-99c (01-09).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Representative Payee Monitoring	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 266

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	G-99A (04-07)	Representative Payee Report	Form G-99A (04-07).pdf		No		Paper Only
Form	G-99C (01-09)	Representative Payee Evaluation Report	Form G-99c (01-09).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: RRB-22; Railroad Retirement Survivor and Pensioner Benefit System	FR Citation: 75 FR 43727

Number of Respondents: 5,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,820	-715	6,535
Annual IC Time Burden (Hours)	1,802	-230	2,032
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.