Information Collection

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

IC 237007 under ICR 202308-0960-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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.	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 Fileable Signable
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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	473,052	473,052
Annual IC Time Burden (Hours)	473,052	473,052
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-4547 - Current	SSA-4547(current).pdf	08/21/2023
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.