Information Collection

Representative Payee Evaluation Report--Private Sector

IC 181092 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form SSA-624 Representative Payee Evaluation Report--Private Sector	Form
SSA-624 Representative Payee Evaluation Report SSA-624 Revised Version.pdf	Form
SSA-624 Current Version.pdf SSA-624 Current Version	IC Document

IC Title:

Representative Payee Evaluation Report--Private Sector

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 404.2065 20 CFR 416.665

Information Collection Instruments:

table that charts list of 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: 64,080

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms

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	64,080	-590	64,670
Annual IC Time Burden (Hours)	32,040	-295	32,335
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.