Information Collection

Representative Payee Monitoring

IC 33950 under ICR 201706-3220-003 · OMB 3220-0151.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0151 can be found here:

Documents and Forms

Document Name Document Type
Form G-99A (12-16) Representative Payee Monitoring Form
G-99A (12-16) Representative Payee Report Form G-99A (12-16).pdf Form
G-99C (12-16) Representative Payee Evaluation Report Form G-99C (12-16).pdf Form
G-106 (Proposed) Statement of Care and Responsibility to Annuitant Form G-106 (Proposed).pdf Form
Form RL-106 (Proposed).pdf Transmittal Letter for Form G-106 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Representative Payee Monitoring	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 266

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	G-99A (12-16)	Representative Payee Report	Form G-99A (12-16).pdf	No	Paper Only
Form	G-99C (12-16)	Representative Payee Evaluation Report	Form G-99C (12-16).pdf	No	Paper Only
Form	G-106 (Proposed)	Statement of Care and Responsibility to Annuitant	Form G-106 (Proposed).pdf	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: RRB-22; Railroad Retirement Survivor and Pensioner Benefit System	FR Citation: 79 FR 58874

Number of Respondents: 5,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,320	500	5,820
Annual IC Time Burden (Hours)	1,885	83	1,802
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Transmittal Letter for Form G-106	Form RL-106 (Proposed).pdf	06/16/2017

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