New Registration Due to Representative Payee Medicare Replacement Card Application (RpMRC)

SSA's Public Credentialing and Authentication Process

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0789 can be found here:

Documents and Forms

Document Name Document Type
eAccess Screen Package.pdf www.ssa.gov Other-Internet Screens
eAccess Screen Package.pdf www.ssa.gov Other-Internet Screens
Revised eAccess Screens - March 2021.pdf www.ssa.gov Other-Internet Screens
Revised eAccess Screens - March 2021.pdf www.ssa.gov Other-Internet Screens

Information Collection (IC) Details

IC Title:	New Registration Due to Representative Payee Medicare Replacement Card Application (RpMRC)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 401.45 20 CFR 402

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			eAccess Screen Package.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-Internet Screens			Revised eAccess Screens - March 2021.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12,500	12,500
Annual IC Time Burden (Hours)	1,667	1,667
Annual IC Cost Burden (Dollars)	2,250	2,250

Documents for IC

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.