Information Collection

Representative Payee Parental Custody Monitoring

IC 33983 under ICR 201708-3220-002 · OMB 3220-0176.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0176 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-99D (04-17) Representative Payee Parental Custody Monitoring	Form and Instruction
G-99D (04-17) Parental Custody Report Form G-99D (04-17).pdf	Form and Instruction
Form G-99A (07-14).pdf Representative Payee Report	IC Document
Form G-99C (07-14).pdf Representative Payee Evaluation	IC Document

IC Title:

Representative Payee Parental Custody 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 266.7

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	G-99D (04-17)	Parental Custody Report	Form G-99D (04-17).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: 800

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	800	-230	1,030
Annual IC Time Burden (Hours)	67	-19	86
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Representative Payee Report	Form G-99A (07-14).pdf	08/25/2017
Representative Payee Evaluation	Form G-99C (07-14).pdf	08/25/2017

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