SSA-6234: Representative Payee Report (Organization)

Representative Payee Report (Adult, Child, and Organizational Representative Payee)

Documents and Forms

Document Name Document Type
Rep Payee Insert.pdf Other-Information Insert for Paper F
SSA-6234 Representative Payee Report (Organization) SSA-6234-OCR-SM - Revised.pdf Form
SSA-6234-OCR-SM - Current.pdf SSA-6234-OCR-SM - Current IC Document

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Information Insert for Paper Forms Re New Internet Option			Rep Payee Insert.pdf		No		Paper Only
Form	SSA-6234	Representative Payee Report (Organization)	SSA-6234-OCR-SM - Revised.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: 497,505	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	497,505	-68,567	566,072
Annual IC Time Burden (Hours)	124,376	-17,142	141,518
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-6234-OCR-SM - Current	SSA-6234-OCR-SM - Current.pdf	08/27/2020

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