Information Collection

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

IC 237007 under ICR 202208-0960-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form SSA-4547 Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547)	Form
Form SSA-4547 Advance Designation of Representative Payee 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

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4547	Yes	No	Fillable Printable
Other-Revised PA & PRA Statements		Yes	No	Fillable Printable
Other-Intranet Advance Designation of Representative Payee Screens		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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
SSA-4547 - Current		10/27/2022
Intranet Advance Designation of Representative Payee Screen Package - Current		10/27/2022

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

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