Information Collection

Representative Payee Report of Benefits and Dedicated Account, 20 CFR 416.546 & 640, and 20 CFR 416.635 & 665

IC 9534 under ICR 201506-0960-009 · OMB 0960-0576.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0576 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-6233 Representative Payee Report of Benefits and Dedicated Account, 20 CFR 416.546 & 640, and 20 CFR 416.635 & 665	Form and Instruction
SSA-6233 - Revised PA and PRA.pdf	Other-Revised Privacy Act and Paperw
SSA-6233 Representative Payee Report of Benefits and Dedicated Ac SSA-6233 (revised).pdf	Form and Instruction
SSA-6233 - Current Version.pdf Current SSA-6233	IC Document

IC Title:

Representative Payee Report of Benefits and Dedicated Account, 20 CFR 416.546 & 640, and 20 CFR 416.635 & 665

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 416.665 20 CFR 416.546 20 CFR 416.635 20 CFR 416.640

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 and Instruction	SSA-6233	Representative Payee Report of Benefits and Dedicated Account	SSA-6233 (revised).pdf		Yes	No	Fillable Printable
Other-Revised Privacy Act and Paperwork Reduction Act			SSA-6233 - Revised PA and PRA.pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	10,000	10,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-6233	SSA-6233 - Current Version.pdf	09/04/2015

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