Information Collection

Advance Designation of Representative Payee (SSA-4547 )

IC 237007 under ICR 202002-0960-005 · OMB 0960-0814.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0814 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-4547 Advance Designation of Representative Payee (SSA-4547 )	Form
SSA-4547 Advance Designation of Representative Payee SSA-4547 mock-up.pdf	Form

IC Title:

Advance Designation of Representative Payee (SSA-4547 )

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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	SSA-4547	Advance Designation of Representative Payee	SSA-4547 mock-up.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 85,733

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 New Statute
Annual Number of Responses for this IC	85,733	85,733
Annual IC Time Burden (Hours)	8,573	8,573
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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