Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547)

Advance Designation of Representative Payee

⚠️ Notice: This information collection may be referencing outdated material.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 (Intranet Version - Paper Form SSA-4547) Form
SSA-4547 - Revised PA & PRA Statements.pdf Other-Revised PA & PRA Statements
SSA-4547 - Revised PA & PRA Statements.pdf Other-Revised PA & PRA Statements
Intranet Advance Designation of Representative Payee Screen Package - Revised.pdf Other-Intranet Advance Designation o
Intranet Advance Designation of Representative Payee Screen Package - Revised.pdf Other-Intranet Advance Designation o
SSA-4547 Advance Designation of Representative Payee SSA-4547 - Revised.pdf Form
SSA-4547 Advance Designation of Representative Payee SSA-4547 - Revised.pdf Form
SSA-4547 - Current.pdf SSA-4547 - Current IC Document
SSA-4547 - Current.pdf SSA-4547 - Current IC Document
Intranet Advance Designation of Representative Payee Screen Package - Current.pdf Intranet Advance Designation of Representative Payee Screen Package - Current IC Document
Intranet Advance Designation of Representative Payee Screen Package - Current.pdf Intranet Advance Designation of Representative Payee Screen Package - Current IC Document

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4547	Advance Designation of Representative Payee	SSA-4547 - Revised.pdf	Yes	No	Fillable Printable
Other-Revised PA & PRA Statements			SSA-4547 - Revised PA & PRA Statements.pdf	Yes	No	Fillable Printable
Other-Intranet Advance Designation of Representative Payee Screens			Intranet Advance Designation of Representative Payee Screen Package - Revised.pdf	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 473,052	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	473,052	387,319	85,733
Annual IC Time Burden (Hours)	473,052	464,479	8,573
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-4547 - Current	SSA-4547 - Current.pdf	10/27/2022
Intranet Advance Designation of Representative Payee Screen Package - Current	Intranet Advance Designation of Representative Payee Screen Package - Current.pdf	10/27/2022

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