Information Collection

Representative Payee Monitoring

IC 33950 under ICR 202405-3220-003 · OMB 3220-0151.

Documents and Forms

Document Name Document Type
Form G-99A (08-21) Representative Payee Monitoring Form
G-99A (08-21) Representative Payee Report Form G-99A - (08-21).pdf Form
G-99A (08-21) Representative Payee Report Form G-99A - (08-21).pdf Form
G-99C (08-21) Representative Payee Evaluation Report Form G-99C - (08-21).pdf Form
G-99C (08-21) Representative Payee Evaluation Report Form G-99C - (08-21).pdf Form
Form G-106 (11-17) Statement of Care and Responsibility to Annuitant Form G-106 (11-17).pdf Form
Form G-106 (11-17) Statement of Care and Responsibility to Annuitant Form G-106 (11-17).pdf Form
Form G-106 (xx-xx) Statement of Care and Responsibility to Annuitant Form G-106 - Proposed.pdf Form
Form G-106 (xx-xx) Statement of Care and Responsibility to Annuitant Form G-106 - Proposed.pdf Form
Form RL-106 (11-17).pdf Transmittal Letter for Form G-106 IC Document
Form RL-106 (11-17).pdf Transmittal Letter for Form G-106 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Representative Payee Monitoring	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 266

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	G-99A (08-21)	Representative Payee Report	Form G-99A - (08-21).pdf	No	Paper Only
Form	G-99C (08-21)	Representative Payee Evaluation Report	Form G-99C - (08-21).pdf	No	Paper Only
Form	Form G-106 (11-17)	Statement of Care and Responsibility to Annuitant	Form G-106 (11-17).pdf	No	Paper Only
Form	Form G-106 (xx-xx) - Proposed	Statement of Care and Responsibility to Annuitant	Form G-106 - Proposed.pdf	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: RRB-22; Railroad Retirement Survivor and Pensioner Benefit System	FR Citation: 79 FR 58874

Number of Respondents: 6,220	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,220	-100	6,320
Annual IC Time Burden (Hours)	1,855	-30	1,885
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Transmittal Letter for Form G-106	Form RL-106 (11-17).pdf	11/19/2020

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