Application to Collect A Fee for Payee Services

Application to Collect A Fee for Payee Services

OMB: 0960-0719

IC ID: 9776

Information Collection (IC) Details

View Information Collection (IC)

Application to Collect A Fee for Payee Services
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.640(a) 20 CFR 404.2040(a)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-445 Application to Collect a Fee for Payee Services (State/local government) MOCK UP SSA-445 (revised).pdf No   Paper Only

Income Security General Retirement and Disability

 

10 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 10 0 0 0 0 10
Annual IC Time Burden (Hours) 2 0 0 0 0 2
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-445 (current) SSA-445 (current).pdf 10/14/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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