Information Collection

SSA-6234: Representative Payee Report (Organization)

IC 185841 under ICR 201812-0960-005 · OMB 0960-0068.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0068 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-6234 SSA-6234: Representative Payee Report (Organization)	Form
Rep Payee Insert.pdf	Other-Information Insert for Paper F
Revised PA and PRA Statements.pdf	Other-Revised PA and PRA Statements
SSA-6234 Representative Payee Report (Organization) SSA-6234-F6 - Revised.pdf	Form
SSA-6234-F6 - Current.pdf Current SSA-6234	IC Document

IC Title:

SSA-6234: Representative Payee Report (Organization)

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 404.2065 20 CFR 416.665 20 CFR 404.2035 20 CFR 404.635

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-6234	Representative Payee Report (Organization)	SSA-6234-F6 - Revised.pdf	No	Fillable Printable
Other-Information Insert for Paper Forms Re New Internet Option			Rep Payee Insert.pdf	No	Paper Only
Other-Revised PA and PRA Statements			Revised PA and PRA Statements.pdf	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 566,072

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	566,072	-153,612	719,684
Annual IC Time Burden (Hours)	141,518	-38,403	179,921
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-6234	SSA-6234-F6 - Current.pdf	04/12/2017

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