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Representative Payee Evaluation Report--Private Sector

IC 181092 under ICR 202603-0960-018 · OMB 0960-0069.

Documents and Forms
Document Name
Document Type
Form
Other-Revised PA Statement
Form
IC Document
Information Collection (IC) Details

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Representative Payee Evaluation Report--Private Sector
 
No Modified
 
Mandatory
 
20 CFR 416.665 20 CFR 404.2065

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-624-F5 Representative Payee Evaluation Report SSA-624-F5 (revised).pdf Yes No Fillable Printable
Other-Revised PA Statement Privacy Act Statement (revised).docx Yes No Fillable Printable

Income Security General Retirement and Disability

 

260 0
   
Private Sector Farms, Businesses or other for-profits
 
   0 %

  Requested 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 260 0 0 -3 0 263
Annual IC Time Burden (Hours) 468 0 0 100 0 368
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-624-F5 - Current SSA-624-F5 (current).pdf 04/13/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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