Representative Payee Report of Benefits and Dedicated Account, 20 CFR 416.546 & 640, and 20 CFR 416.635 & 665

Representative Payee Report of Benefits and Dedicated Account

OMB: 0960-0576

IC ID: 9534

Information Collection (IC) Details

View Information Collection (IC)

Representative Payee Report of Benefits and Dedicated Account, 20 CFR 416.546 & 640, and 20 CFR 416.635 & 665
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.546 20 CFR 416.640 20 CFR 416.665 20 CFR 416.635

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-6233-BK Representative Payee Report of Benefits and Dedicated Account SSA-6233-BK - Revised.pdf Yes No Fillable Printable
Other-Revised PA and PRA Statements Revised PA & PRA Statements.pdf Yes No Fillable Printable

Income Security General Retirement and Disability

 

31,500 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 31,500 0 0 -4,728 0 36,228
Annual IC Time Burden (Hours) 10,500 0 0 -1,576 0 12,076
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-6233-BK - Current SSA-6233-BK - Current.pdf 11/01/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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