Representative Payee Evaluation Report

Forms and Documents

Document Name	Status
Form SSA-624-F5 Representative Payee Evaluation Report--Individuals/Households Form	Modified
Form SSA-624-F5 Representative Payee Evaluation Report--Private Sector Form	Modified
Form SSA-624-F5 Representative Payee Evaluation Report--State/Local Government Form	Modified
Addendum - 0069.docx Supplementary Document	2019-08-01
Supporting Statement - 0069.docx Supporting Statement A	2019-08-01

IC Document Collections

IC ID	Document Title	Status
9009	Representative Payee Evaluation Report--Individuals/Households Form	Modified
181092	Representative Payee Evaluation Report--Private Sector Form	Modified
181091	Representative Payee Evaluation Report--State/Local Government Form	Modified

ICR Details

OMB Control No: 0960-0069	ICR Reference No: 201904-0960-003
Status: Active	Previous ICR Reference No: 201603-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Representative Payee Evaluation Report
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/20/2019
	Date Received in OIRA: 08/01/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2022	36 Months From Approved	10/31/2019
Responses	7,276	0	267,000
Time Burden (Hours)	3,638	0	133,500
Cost Burden (Dollars)	0	0	0

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Abstract: Sections 205(j) and 1631(a)(2) of the Social Security Act (Act) state that SSA may authorize payment of Social Security benefits or Supplemental Security Income (SSI) payments to a representative payee on behalf of individuals unable to manage, or direct the management of, those funds themselves. SSA requires appointed representative payees to report once each year on how they used or conserved those funds. When a representative payee fails to adequately report to SSA as required, SSA conducts a face to-face interview with the payee and completes Form SSA-624-F5, Representative Payee Evaluation Report, to determine the continued suitability of the representative payee to serve as a payee. In addition to interviewing the representative payee, we also interview the recipient, and custodian (if other than the payee), to confirm the information the payee provides, and to ensure the payee is meeting the recipient’s current needs. The respondents are individuals or organizations serving as representative payees for individuals receiving Title II benefits or Title XVI payments, who fail to comply with SSA’s statutory annual reporting requirement, and the recipients for whom they act as payee.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: PL: Pub.L. 115 - 165 102 Name of Law: Strengthening Protections for Social Security Benefits Act of 2018

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 23623	05/22/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 37704	08/01/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Representative Payee Evaluation Report--Individuals/Households	SSA-624-F5	Representative Payee Evaluation Report
Representative Payee Evaluation Report--Private Sector	SSA-624-F5	Representative Payee Evaluation Report
Representative Payee Evaluation Report--State/Local Government	SSA-624-F5	Representative Payee Evaluation Report

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	7,276	267,000	-259,724	0	0	0
Annual Time Burden (Hours)	3,638	133,500	-129,862	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The decrease in the public reporting burden from 133,500 to 3,638 is due to legislative changes we are implementing because of Section 102 of the Strengthening Protections for Social Security Benefits Act of 2018 (Pub.L. 115 165). Section 102 of Pub.L. 115-165 exempts custodial parents of minor children and disabled individuals, as well as spouses, from annual payee accountings. Due to the provisions of this law, we expect a drastic reduction in the number of respondents for the form SSA-624 because the majority of the previous respondents fall into one of the exemption categories under this new law.

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Annual Cost to Federal Government: $92,514

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/01/2019

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