Information Collection

SSA-623: Representative Payee Report (Adult Beneficiaries)

IC 9006 under ICR 202004-0960-014 · OMB 0960-0068.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-623 SSA-623: Representative Payee Report (Adult Beneficiaries)	Form
Form SSA-623 Representative Payee Report (Adult) SSA-623: Representative Payee Report (Adult Beneficiaries)	Form
Rep_Payee_Insert[1].pdf	Other-Information Insert for Paper F
Rep_Payee_Insert[1].pdf	Other-Information Insert for Paper F
SSA-623 Representative Payee Report (Adult) SSA-623-OCR-SM - Revised.pdf	Form
SSA-623 Representative Payee Report (Adult) SSA-623-OCR-SM - Revised.pdf	Form
SSA-623-OCR-SM - Current.pdf SSA-623-OCR-SM - Current	IC Document
SSA-623-OCR-SM - Current.pdf SSA-623-OCR-SM - Current	IC Document

IC Title:

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 404.635 20 CFR 404.2035

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-623				No		Fillable Printable
Other-Information Insert for Paper Forms Re New Internet Option					No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,086,152

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,086,152	-1,069,422	2,155,574
Annual IC Time Burden (Hours)	1,357,690	818,796	538,894
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-623-OCR-SM - Current		08/27/2020

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

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