Information Collection

Applicaiton To Collect A Fee For Payee Services (Private Sector Business)

IC 188037 under ICR 202405-0960-004 · OMB 0960-0719.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-445 Applicaiton To Collect A Fee For Payee Services (Private Sector Business)	Form
SSA-445 Application To Collect A Fee For Payee Services (Private SSA-445.pdf	Form
SSA-445 Application To Collect A Fee For Payee Services (Private SSA-445.pdf	Form

IC Title:

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 404.2040 20 CFR 416.640

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-445	Application To Collect A Fee For Payee Services (Private Sector)	SSA-445.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: 80

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	80	-10	90
Annual IC Time Burden (Hours)	97	77	20
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.