Information Collection

I4547 (internet version)

IC 237013 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
iClaim Advance Designation of Representative Payee Screen Package.pdf	Other-iClaim Internet Screens
iClaim Advance Designation of Representative Payee Screen Package.pdf	Other-iClaim Internet Screens
mySSA Advance Designation of Representative Payee Screen Package_9.26 Alternative V1.3.pdf	Other-mySSA Internet Screens
mySSA Advance Designation of Representative Payee Screen Package_9.26 Alternative V1.3.pdf	Other-mySSA Internet Screens
Advance Designation of Representative Payee Annual Notice (revised).pdf	Other-Annual Notice
Advance Designation of Representative Payee Annual Notice (revised).pdf	Other-Annual Notice
Advance Designation of Represenative Payee Receipts (revised).pdf	Other-Payee Receipts
Advance Designation of Represenative Payee Receipts (revised).pdf	Other-Payee Receipts
Advance Designation of Representative Payee Annual Notice (current).pdf Annual Notice	IC Document
Advance Designation of Representative Payee Annual Notice (current).pdf Annual Notice	IC Document
Advance Designation of Represenative Payee Receipts (current).pdf Payee Receipts	IC Document
Advance Designation of Represenative Payee Receipts (current).pdf Payee Receipts	IC Document

IC Title:

I4547 (internet version)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-iClaim Internet Screens	Yes	Yes	Fillable Fileable Signable
Other-mySSA Internet Screens	Yes	Yes	Fillable Fileable Signable
Other-Annual Notice	Yes	No	Paper Only
Other-Payee Receipts	Yes	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,201,466

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	Previously Approved
Annual Number of Responses for this IC	3,201,466	3,201,466
Annual IC Time Burden (Hours)	320,147	320,147
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Annual Notice		08/24/2021
Payee Receipts		08/24/2021

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

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