Application for Substitution of Payee and Duties as Representative Payee (Institutions)

Application to Act as Representative Payee

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0052 can be found here:

Documents and Forms

Document Name Document Type
Form AA-5 Application for Substitution of Payee and Duties as Representative Payee (Institutions) Form and Instruction
AA-5 Application for Substitution of Payee Form AA-5 (05-17).pdf Form and Instruction
RB-5 Your Duties as Representative Payee-Representative's Pay Form RB-5 (05-17) paper.pdf Form and Instruction
Form SSA-11-BK (01-14).pdf SSA-11-BK (1-2014) IC Document

Information Collection (IC) Details

IC Title:	Application for Substitution of Payee and Duties as Representative Payee (Institutions)	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 20 CFR 267 20 CFR 269

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	AA-5	Application for Substitution of Payee	Form AA-5 (05-17).pdf		No		Paper Only
Form and Instruction	RB-5	Your Duties as Representative Payee-Representative's Payee's Record	Form RB-5 (05-17) paper.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: 3,825	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,575	4,575
Annual IC Time Burden (Hours)	4,038	4,038
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-11-BK (1-2014)	Form SSA-11-BK (01-14).pdf	08/22/2016

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