Advance Designation of Representative Payee (Internet Version - mySSA)

Advance Designation of Representative Payee

OMB: 0960-0814

IC ID: 237013

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0814 can be found here:

2023-08-23 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
mySSA Advance Designation of Representative Payee Screen Package - Revised.pdf Other-mySSA Advance Designation of R
mySSA Advance Designation of Representative Payee Screen Package - Revised.pdf Other-mySSA Advance Designation of R
Advance Designation of Representative Payee Annual Notice - Revised.pdf Other-Advance Designation of Represe
Advance Designation of Representative Payee Annual Notice - Revised.pdf Other-Advance Designation of Represe
Advance Designation of Represenative Payee Receipts - Revised.pdf Other-Advance Designation of Represe
Advance Designation of Represenative Payee Receipts - Revised.pdf Other-Advance Designation of Represe
mySSA Advance Designation of Representative Payee Screen Package - Current.pdf mySSA Advance Designation of Representative Payee Screen Package - Current IC Document
mySSA Advance Designation of Representative Payee Screen Package - Current.pdf mySSA Advance Designation of Representative Payee Screen Package - Current IC Document
Advance Designation of Representative Payee Annual Notice - Current.pdf Advance Designation of Representative Payee Annual Notice - Current IC Document
Advance Designation of Representative Payee Annual Notice - Current.pdf Advance Designation of Representative Payee Annual Notice - Current IC Document
Advance Designation of Represenative Payee Receipts - Current.pdf Advance Designation of Represenative Payee Receipts - Current IC Document
Advance Designation of Represenative Payee Receipts - Current.pdf Advance Designation of Represenative Payee Receipts - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Advance Designation of Representative Payee (Internet Version - mySSA)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-mySSA Advance Designation of Representative Payee Screens	mySSA Advance Designation of Representative Payee Screen Package - Revised.pdf	Yes	Yes	Fillable Fileable Signable
Other-Advance Designation of Representative Payee Annual Notice	Advance Designation of Representative Payee Annual Notice - Revised.pdf	No		Paper Only
Other-Advance Designation of Represenative Payee Receipts	Advance Designation of Represenative Payee Receipts - Revised.pdf	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 327,101	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	327,101	-2,874,365	3,201,466
Annual IC Time Burden (Hours)	32,710	-287,437	320,147
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
mySSA Advance Designation of Representative Payee Screen Package - Current	mySSA Advance Designation of Representative Payee Screen Package - Current.pdf	10/27/2022
Advance Designation of Representative Payee Annual Notice - Current	Advance Designation of Representative Payee Annual Notice - Current.pdf	10/27/2022
Advance Designation of Represenative Payee Receipts - Current	Advance Designation of Represenative Payee Receipts - Current.pdf	10/27/2022

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