Representative Payee Evaluation Report--Individuals/Households

Representative Payee Evaluation Report

⚠️ Notice: This information collection may be referencing outdated material.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--Individuals/Households 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

IC Title:	Representative Payee Evaluation Report--Individuals/Households	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 416.665 20 CFR 404.2065

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: 194,910	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	194,910	1,990	192,920
Annual IC Time Burden (Hours)	97,455	995	96,460
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.