OMB.report

Federal forms, ICRs, and supporting documents

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 NameDocument Type
Form AA-5
Application for Substitution of Payee Application for Substitution of Payee and Duties as Representative Payee (Institutions)		 Form and Instruction
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 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 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
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
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
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
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
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
Form SSA-11-BK (09-20).pdf
SSA-11-BK (09-2020)		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
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

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 4,575 0 0 0 0 4,575
Annual IC Time Burden (Hours) 4,038 0 0 0 0 4,038
Annual IC Cost Burden (Dollars) 0 0 0 0 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.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].