Information Collection

Application for Substitution of Payee and Duties as Representative Payee (Institutions)

IC 179617 under ICR 202507-3220-004 · OMB 3220-0052.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AA-5 Application for Substitution of Payee Application for Substitution of Payee and Duties as Representative Payee (Institutions)	Form and Instruction
Form RB-5 Your Duties as Representative Payee-Representative's Payee's Record Application for Substitution of Payee and Duties as Representative Payee (Institutions)	Form and Instruction
Form AA-5 (xx-xx) Application for Substitution of Payee Application for Substitution of Payee and Duties as Representative Payee (Institutions)	Form and Instruction
Form RB-5 (xx-xx) Your Duties as Representative Payee - Representative's Payee's Record Application for Substitution of Payee and Duties as Representative Payee (Institutions)	Form and Instruction
AA-5 Application for Substitution of Payee AA-5 (11-23).pdf	Form and Instruction
RB-5 Your Duties as Representative Payee-Representative's Pay Form RB-5 (07-23) - Current.pdf	Form and Instruction
AA-5 (xx-xx) Application for Substitution of Payee Form AA-5 (XX-XX) - Proposed.pdf	Form and Instruction
RB-5 (xx-xx) Your Duties as Representative Payee - Representative's P Form RB-5 (XX-XX) - Proposed.pdf	Form and Instruction
Form SSA-11-BK (09-20).pdf SSA-11-BK (09-2020)	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 266 20 CFR 267 20 CFR 269

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form and Instruction	AA-5	No	Paper Only
Form and Instruction	RB-5	No	Paper Only
Form and Instruction	AA-5 (xx-xx)	No	Paper Only
Form and Instruction	RB-5 (xx-xx)	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: RRB-22, Railroad Retirement, Survivor, and Pensioner Benefit System

FR Citation: 79 FR 58874

Number of Respondents: 4,575

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	4,575	4,575
Annual IC Time Burden (Hours)	4,038	4,038
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-11-BK (09-2020)		05/28/2026

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

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