Information Collection

Representative Payee Evaluation Report--State/Local Government

IC 181091 under ICR 201305-0960-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Revised Version.pdf Form
SSA-624 Current Version.pdf SSA-624 Current Version IC Document

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 404.2062 20 CFR 416.665

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 Revised Version.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: 8,010	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	8,010	-400	8,410
Annual IC Time Burden (Hours)	4,005	-200	4,205
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-624 Current Version	SSA-624 Current Version.pdf	05/09/2013

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