Information Collection

Advance Designation of Representative Payee (SSA-4547 )

IC 237007 under ICR 202108-0960-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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
SSA-4547 Advance Designation of Representative Payee SSA-4547 mock-up.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Advance Designation of Representative Payee (SSA-4547 )	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	Approved	Previously Approved
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

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.