Information Collection

Applicaiton To Collect A Fee For Payee Services (Private Sector Business)

IC 188037 under ICR 201407-0960-006 · OMB 0960-0719.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0719 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-445 Applicaiton To Collect A Fee For Payee Services (Private Sector Business)	Form
SSA-445 Application To Collect A Fee For Payee Services (Private SSA-445 (revised).pdf	Form
ssa445(current).pdf SSA-445 (current)	IC Document

IC Title:

Applicaiton To Collect A Fee For Payee Services (Private Sector Business)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.640 20 CFR 404.2040

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-445	Application To Collect A Fee For Payee Services (Private Sector)	SSA-445 (revised).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: 90

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-445 (current)	ssa445(current).pdf	07/25/2014

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