Information Collection

Advance Designation of Representative Payee (Internet Version - mySSA)

IC 237013 under ICR 202507-0960-004 · OMB 0960-0814.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Advance Designation - mySSA Screen Package.pdf	Other-mySSA Advance Designation of R
Advance Designation - mySSA Screen Package.pdf	Other-mySSA Advance Designation of R
Advance Designation - Annual Notice.pdf	Other-Advance Designation of Represe
Advance Designation - Annual Notice.pdf	Other-Advance Designation of Represe
Advance Designation - Internet Privacy Act Statement.pdf	Other-Advance Designation of Represe
Advance Designation - Internet Privacy Act Statement.pdf	Other-Advance Designation of Represe

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-mySSA Advance Designation of Representative Payee Screens	www.ssa.gov (mySocial Security Account)	Yes	Yes	Fillable Fileable Signable
Other-Advance Designation of Representative Payee Annual Notice		No		Paper Only
Other-Advance Designation of Representative Payee Privacy Act Statement Screen	www.ssa.gov (mySocial Security Account)	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 304,471

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	304,471	-22,630	327,101
Annual IC Time Burden (Hours)	182,683	149,973	32,710
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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