Individuals/Households: Paper SSA-11-BK

Request to be Selected as a Payee

Documents and Forms

Document Name Document Type
Form SSA-11-BK Individuals/Households: Paper SSA-11-BK Form
SSA-11-BK Request to be Selected as a Payee SSA-11-BK.pdf Form
SSA-11-BK Request to be Selected as a Payee SSA-11-BK.pdf Form

Information Collection (IC) Details

IC Title:	Individuals/Households: Paper SSA-11-BK	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 416.601-416.665 20 CFR 404.2010-404.2055

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-11-BK	Request to be Selected as a Payee	SSA-11-BK.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: 70,452	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	70,452	2,052	68,400
Annual IC Time Burden (Hours)	14,090	410	13,680
Annual IC Cost Burden (Dollars)	0	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.