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

Forms and Documents

Document Name	Status
Form SSA-623 SSA-623: Representative Payee Report (Adult Beneficiaries) Form	Modified
Form SSA-6234 SSA-6234: Representative Payee Report (Organization) Form	Modified
Form SSA-6230 SSA-6230: Representative Payee Report (Child Beneficiaries) Form	Modified
Addendum - 0068.doc Supplementary Document	2014-03-12
Supporting Statement 0068 (revised).doc Supporting Statement A	2014-06-24

IC Document Collections

IC ID	Document Title	Status
9006	SSA-623: Representative Payee Report (Adult Beneficiaries) Form	Modified
185842	iRPA: Internet Representative Payee Report Other-Online application	Modified
185841	SSA-6234: Representative Payee Report (Organization) Form	Modified
185840	SSA-6230: Representative Payee Report (Child Beneficiaries) Form	Modified

ICR Details

OMB Control No: 0960-0068	ICR Reference No: 201403-0960-003
Status: Historical Active	Previous ICR Reference No: 201103-0960-004
Agency/Subagency: SSA	Agency Tracking No:
Title: Representative Payee Report (Adult, Child, and Organizational Representative Payee)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/25/2014
	Date Received in OIRA: 06/25/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved	08/31/2014
Responses	7,149,384	0	6,608,900
Time Burden (Hours)	1,787,346	0	1,652,225
Cost Burden (Dollars)	0	0	0

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Abstract: When SSA determines it is not in beneficiaries' best interests to receive their Social Security benefits payments directly, the Agency will designate a family member, unrelated person, or organization to act as the representative payee for such beneficiaries. Representative payees must account to SSA about how they use these payments on their beneficiaries' behalf; they use forms SSA-623 (for adult beneficiaries), SSA-6230 (for child beneficiaries), and SSA-6234 (organizational rep payees) to do so. This ICR is for three changes to the collection: 1) we are clearing an Internet version of the Representative Payee Report, 2) we are combining all three paper forms under one OMB number, 0960-0068, and 3) we are making minor formatting changes to the first page of the paper forms' instructions.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 17632	03/28/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 34824	06/18/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
SSA-623: Representative Payee Report (Adult Beneficiaries)	SSA-623	Representative Payee Report (Adult)
SSA-6234: Representative Payee Report (Organization)	SSA-6234	Representative Payee Report (Organization)
SSA-6230: Representative Payee Report (Child Beneficiaries)	SSA-6230	Representative Payee Report (Child)
iRPA: Internet Representative Payee Report

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	7,149,384	6,608,900	0	0	540,484	0
Annual Time Burden (Hours)	1,787,346	1,652,225	0	0	135,121	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There has been an increase in burden hours. The increase stems from an increase in the number of respondents completing the three paper forms.

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/25/2014

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