Advance Designation of Representative Payee

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-4547 Advance Designation of Representative Payee (SSA-4547 )	Form	New	Repair queued
Suppporting Statement- 0960-NEW ( Rep Payee Section 201).docx	Supporting Statement A	Uploaded 2019-11-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
237014	SSA-4547 Intranet version (SSI Claims System; MCS; iMAIN)	Other-SSA-4547 Intranet screens	New
237013	I4547 (internet version)	Other-iClaim Internet Screens	New
237007	Advance Designation of Representative Payee (SSA-4547 )	Form	New

ICR Details

OMB Control No: 0960-0814	ICR Reference No: 201907-0960-005
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Advance Designation of Representative Payee
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Preapproved	Conclusion Date: 01/10/2020
	Date Received in OIRA: 11/26/2019
Terms of Clearance: This collection is approved pursuant to 5 CFR 1320.11(g). The agency may collect the information upon finalization of the rulemaking without resubmitting to OMB, unless the collection has substantively or materially changed (see 5 CFR 1320.11(h)).

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2023	36 Months From Approved
Responses	11,739,165	0	0
Time Burden (Hours)	1,173,917	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: On April 13, 2018, the President signed into law The Strengthening Protections for Social Security Beneficiaries Act of 2018, also known as Pub.L.115-165. Section 201 of the law allows SSA beneficiaries and applicants under Title II, Title VIII and Title XVI, of the Act to designate individuals to serve as a representative payee should the need arise in the future. Section 201(j)(2) of the Act provides the requirements for selecting a qualified representative payee. SSA only offers the option to advance designate to capable adults and emancipated minors. Beneficiaries who have an assigned representative payee, or have a representative application in process, cannot advance designate. Form SSA-4547, Advance Designation of Representative Payee, allows beneficiaries or applicants the option to designate individuals in order of priority, to serve as a representative. Beneficiaries or applicants can update or change the advance designee order of priority at any time. SSA uses the information on Form SSA-4547 to select a qualified representative payee in order of priority. If the selected representative payee is unable or unwilling to serve, or meet SSA requirements. SSA will select another representative payee to serve in the beneficiaries and applicants best interest. SSA will notify beneficiaries annually of the individuals they chose in advance to be their representative payee. The respondents are SSA beneficiaries and claimants who want to choose an advance designate representative.

---

Authorizing Statute(s): PL: Pub.L. 115 - 165 201 Name of Law: The Strengthening Protections for Social Security Beneficiaries Act of 2018
  

Citations for New Statutory Requirements: PL: Pub.L. 115 - 165 201 Name of Law: Protections for Social Security Beneficiaries Act of 2018

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0960-AI33	Proposed rulemaking	84 FR 65040	11/26/2019

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 40121	08/13/2019
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Advance Designation of Representative Payee (SSA-4547 )	SSA-4547	Advance Designation of Representative Payee
I4547 (internet version)
SSA-4547 Intranet version (SSI Claims System; MCS; iMAIN)

---

ICR Summary of Burden

table that charts list of burden

	Total Request	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	11,739,165	0	11,739,165	0	0	0
Annual Time Burden (Hours)	1,173,917	0	1,173,917	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: To accommodate the new regulations, we created a new form, the SSA-4547. The new Form SSA-4547 increases the public reporting burden.

---

Annual Cost to Federal Government: $27,884,181

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

---

Common Form ICR:  No

---

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: 11/26/2019

---