Information Collection

SSA-6234: Representative Payee Report (Organization)

IC 185841 under ICR 201103-0960-004 · OMB 0960-0068.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0068 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-6234 SSA-6234: Representative Payee Report (Organization)	Form
SSA-6234 - 1st-page instructions.pdf	Instruction
Rep Payee Insert.pdf	Other-Information Insert for Paper F
SSA-6234 Representative Payee Report (Organization) SSA-6234-OCR-SM - Revised Version.pdf	Form
SSA-6234-OCR-SM - Current Version.pdf Current SSA-6234	IC Document

IC Title:

SSA-6234: Representative Payee Report (Organization)

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 404.2065 20 CFR 416.665 20 CFR 404.2035 20 CFR 404.635

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-6234	Representative Payee Report (Organization)	SSA-6234-OCR-SM - Revised Version.pdf	No	Paper Only
Instruction			SSA-6234 - 1st-page instructions.pdf	No	Paper Only
Other-Information Insert for Paper Forms Re New Internet Option			Rep Payee Insert.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: 702,100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	702,100	75,225	626,875
Annual IC Time Burden (Hours)	175,525	18,806	156,719
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-6234	SSA-6234-OCR-SM - Current Version.pdf	04/08/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.