Information Collection

Representative Payee Monitoring

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-99A (08-21) Representative Payee Monitoring	Form
Form G-99A (08-21) Representative Payee Report Representative Payee Monitoring	Form
Form G-99C (08-21) Representative Payee Evaluation Report Representative Payee Monitoring	Form
Form Form G-106 (11-17) Statement of Care and Responsibility to Annuitant Representative Payee Monitoring	Form
Form Form G-106 (xx-xx) Statement of Care and Responsibility to Annuitant 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

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 266

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form	G-99A (08-21)	No	Paper Only
Form	G-99C (08-21)	No	Paper Only
Form	Form G-106 (11-17)	No	Paper Only
Form	Form G-106 (xx-xx) - Proposed	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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Transmittal Letter for Form G-106		11/19/2020

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].