Information Collection

Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547)

IC 237007 under ICR 202507-0960-004 · OMB 0960-0814.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-4547 Advance Designation of Representative Payee Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547)	Form
Form SSA-4547 Advance Designation of Representative Payee Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547)	Form
Advance Designation - Intranet Screen Package.pdf	Other-Intranet Advance Designation o
Advance Designation - Intranet Screen Package.pdf	Other-Intranet Advance Designation o
SSA-4547 Advance Designation of Representative Payee SSA- 4547.pdf	Form
SSA-4547 Advance Designation of Representative Payee SSA- 4547.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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
Form	SSA-4547				Yes	No	Fillable Fileable Signable
Other-Intranet Advance Designation of Representative Payee Screens					Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 693,339

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	693,339	220,287	473,052
Annual IC Time Burden (Hours)	855,118	382,066	473,052
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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