Information Collection

Advance Designation of Representative Payee (Internet Version - mySSA)

IC 237013 under ICR 202406-0960-001 · OMB 0960-0814.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0814 can be found here:

2026-03-23 - Revision of a currently approved collection

Documents and Forms

Document Name Document Type
mySSA Advance Designation of Representative Payee Screen Package - Revised.pdf Other-mySSA Advance Designation of R
mySSA Advance Designation of Representative Payee Screen Package - Revised.pdf Other-mySSA Advance Designation of R
Advance Designation of Representative Payee Annual Notice - Revised.pdf Other-Advance Designation of Represe
Advance Designation of Representative Payee Annual Notice - Revised.pdf Other-Advance Designation of Represe
Advance Designation of Represenative Payee Receipts - Revised.pdf Other-Advance Designation of Represe
Advance Designation of Represenative Payee Receipts - Revised.pdf Other-Advance Designation of Represe
Advance Designation of Representative Payee Internet Current Screen (revised).PNG Other-Advance Designation of Represe
Advance Designation of Representative Payee Internet Current Screen (revised).PNG Other-Advance Designation of Represe
Advance Designation RP Screens - PAS Mockup with comments 7.22.24.pdf www.ssa.gov Other-Revised Internet Screens
mySSA Advance Designation of Representative Payee Screen Package - Current.pdf mySSA Advance Designation of Representative Payee Screen Package - Current IC Document
mySSA Advance Designation of Representative Payee Screen Package - Current.pdf mySSA Advance Designation of Representative Payee Screen Package - Current IC Document
Advance Designation of Representative Payee Annual Notice - Current.pdf Advance Designation of Representative Payee Annual Notice - Current IC Document
Advance Designation of Representative Payee Annual Notice - Current.pdf Advance Designation of Representative Payee Annual Notice - Current IC Document
Advance Designation of Represenative Payee Receipts - Current.pdf Advance Designation of Represenative Payee Receipts - Current IC Document
Advance Designation of Represenative Payee Receipts - Current.pdf Advance Designation of Represenative Payee Receipts - Current IC Document
Advance Designation of Representative Payee Internet Screen (current).pdf Advance Designation of Representative Payee Privacy Act Statement Screen (current) IC Document
Advance Designation of Representative Payee Internet Screen (current).pdf Advance Designation of Representative Payee Privacy Act Statement Screen (current) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Advance Designation of Representative Payee (Internet Version - mySSA)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-mySSA Advance Designation of Representative Payee Screens	mySSA Advance Designation of Representative Payee Screen Package - Revised.pdf		Yes	Yes	Fillable Fileable Signable
Other-Advance Designation of Representative Payee Annual Notice	Advance Designation of Representative Payee Annual Notice - Revised.pdf		No		Paper Only
Other-Advance Designation of Represenative Payee Receipts	Advance Designation of Represenative Payee Receipts - Revised.pdf		No		Paper Only
Other-Advance Designation of Representative Payee Privacy Act Statement Screen (revised)	Advance Designation of Representative Payee Internet Current Screen (revised).PNG		Yes	No	Paper Only
Other-Revised Internet Screens	Advance Designation RP Screens - PAS Mockup with comments 7.22.24.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 327,101	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	327,101	327,101
Annual IC Time Burden (Hours)	32,710	32,710
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
mySSA Advance Designation of Representative Payee Screen Package - Current	mySSA Advance Designation of Representative Payee Screen Package - Current.pdf	10/27/2022
Advance Designation of Representative Payee Annual Notice - Current	Advance Designation of Representative Payee Annual Notice - Current.pdf	10/27/2022
Advance Designation of Represenative Payee Receipts - Current	Advance Designation of Represenative Payee Receipts - Current.pdf	10/27/2022
Advance Designation of Representative Payee Privacy Act Statement Screen (current)	Advance Designation of Representative Payee Internet Screen (current).pdf	06/06/2024

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