OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Advance Designation of Representative Payee (Internet Version - mySSA)

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

Documents and Forms

Documents and forms in this information collection
Document NameDocument 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 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)

layout table

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
Other-mySSA Advance Designation of Representative Payee Screens Yes Yes Fillable Fileable Signable
Other-Advance Designation of Representative Payee Annual Notice No   Paper Only
Other-Advance Designation of Represenative Payee Receipts No   Paper Only
Other-Advance Designation of Representative Payee Privacy Act Statement Screen (revised) Yes No Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 327,101 0 0 0 0 327,101
Annual IC Time Burden (Hours) 32,710 0 0 0 0 32,710
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
mySSA Advance Designation of Representative Payee Screen Package - Current 10/27/2022
Advance Designation of Representative Payee Annual Notice - Current 10/27/2022
Advance Designation of Represenative Payee Receipts - Current 10/27/2022
Advance Designation of Representative Payee Privacy Act Statement Screen (current) 06/06/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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