SSA-623: Representative Payee Report (Adult Beneficiaries)

Representative Payee Report (Adult, Child, and Organizational Representative Payee)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form SSA-623 SSA-623: Representative Payee Report (Adult Beneficiaries) Form
SSA-623 - 1st-page instructions.pdf Instruction
Rep Payee Insert.pdf Other-Informational Insert Re New On
SSA-623 Representative Payee Report (Adult) SSA-623-OCR-SM - Revised Version.pdf Form
SSA-623-OCR-SM - Current Version.pdf Current SSA-623 IC Document

Information Collection (IC) Details

IC Title:	SSA-623: Representative Payee Report (Adult Beneficiaries)	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 404.635 20 CFR 404.2035

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-623	Representative Payee Report (Adult)	SSA-623-OCR-SM - Revised Version.pdf	No	Paper Only
Instruction			SSA-623 - 1st-page instructions.pdf	No	Paper Only
Other-Informational Insert Re New Online 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: 2,378,400	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	2,378,400	285,275	2,093,125
Annual IC Time Burden (Hours)	594,600	71,319	523,281
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-623	SSA-623-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.