Advance Designation of Representative Payee

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-4547 Advance Designation of Representative Payee	Form	Modified	Available
Form SSA-4547 Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547)	Form	Modified	Repair queued
Justification for Non-Substantive Changes for 0960-0814.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-06-06	Repair queued
Addendum - 0814.docx	Supplementary Document	Uploaded 2022-10-27	Missing upstream
Supporting Statement - 0814 (Final).docx	Supporting Statement A	Uploaded 2023-01-03	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
256843	Waiver of Advance Designation (Internet Version - iClaim)	Other-iClaim Advance Designation of Representative Payee Screens	Unchanged
256842	Waiver of Advance Designation (Internet Version - mySSA)	Other-mySSA Advance Designation of Representative Payee Screens	Unchanged
256631	Waiver of Advance Designation (Intranet Version)	Other-Intranet Advance Designation of Representative Payee Scree	Unchanged
237014	Advance Designation of Representative Payee (Internet Version - iClaim)	Other-iClaim Advance Designation of Representative Payee Screens	Unchanged
237013	Advance Designation of Representative Payee (Internet Version - mySSA)	Other-mySSA Advance Designation of Representative Payee Screens	Modified
237007	Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547)	Form	Modified	Advance Designation of Representative Payee
237007	Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547)	Form	Modified
237007	Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547)	Other-Intranet Advance Designation of Representative Payee Scree	Modified

ICR Details

OMB Control No: 0960-0814	ICR Reference No: 202406-0960-001
Status: Historical Active	Previous ICR Reference No: 202308-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Advance Designation of Representative Payee
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/22/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/07/2024
Terms of Clearance: The agency modified the proposed display to reduce the number of click-throughs a user has to take prior to accessing the web application. Prior to the development of similar enhancements on other web applications, the agency will consult with OMB to facilitate a better understanding of the relevant usability research supporting such decisions.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2026	03/31/2026	03/31/2026
Responses	2,942,388	0	2,942,388
Time Burden (Hours)	987,364	0	987,364
Cost Burden (Dollars)	0	0	0

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Abstract: On April 13, 2018, the President signed into law The Strengthening Protections for Social Security Beneficiaries Act of 2018, also known as Pub.L.115-165. Section 201 of the law allows SSA beneficiaries and applicants under Title II, Title VIII and Title XVI, of the Act to designate individuals to serve as a representative payee should the need arise in the future. Section 201(j)(2) of the Act provides the requirements for selecting a qualified representative payee. SSA only offers the option to advance designate to capable adults and emancipated minors. Beneficiaries who have an assigned representative payee, or have a representative application in process, cannot advance designate. Form SSA-4547, Advance Designation of Representative Payee, allows beneficiaries or applicants the option to designate individuals in order of priority, to serve as a representative. Beneficiaries or applicants can update or change the advance designee order of priority at any time. SSA uses the information on Form SSA-4547 to select a qualified representative payee in order of priority. If the selected representative payee is unable or unwilling to serve, or meet SSA requirements. SSA will select another representative payee to serve in the beneficiaries and applicants best interest. SSA will notify beneficiaries annually of the individuals they chose in advance to be their representative payee. The respondents are SSA beneficiaries and claimants who want to choose an advance designate representative. We are making minor revisions to the SSA-4547 and the Advance Designation of Representative Payee Internet (MySSA) screens to revise the Privacy Act Statement.

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Authorizing Statute(s): PL: Pub.L. 115 - 165 201 Name of Law: The Strengthening Protections for Social Security Beneficiaries Act of 2018
  

Citations for New Statutory Requirements: PL: Pub.L. 115 - 165 201 Name of Law: Protections for Social Security Beneficiaries Act of 2018

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 60721	10/06/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 80574	12/30/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Advance Designation of Representative Payee (Internet Version - iClaim)
Advance Designation of Representative Payee (Internet Version - mySSA)
Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547)	SSA-4547	Advance Designation of Representative Payee
Waiver of Advance Designation (Internet Version - iClaim)
Waiver of Advance Designation (Internet Version - mySSA)
Waiver of Advance Designation (Intranet Version)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,942,388	2,942,388	0	0	0	0
Annual Time Burden (Hours)	987,364	987,364	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $8,580,542

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/07/2024

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