OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Request to be Selected as a Payee

OMB 0960-0014 · SSA.

OMB 0960-0014

SSA requires individuals applying to be representative payees for OASDI, or SSI recipients to complete Form SSA-11-BK or, supply the same information to a field office technician through a personal interview. SSA obtains information from applicant payees regarding their relationship to the recipient; personal qualifications; concerns for the recipient’s well-being; and intended use of payments if appointed as payee. SSA collects this on paper Form SSA-11-BK, or through eRPS, an electronic version of the form, which field office technicians complete during a face-to-face interview with the applicant. The respondents are individuals; private sector businesses and institutions; and State and local government institutions and agencies applying to become representative payees.

The latest form for Request to be Selected as a Payee expires 2029-07-31 and is listed under ICR 202604-0960-011.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SSA-11-BK Request to be Selected as a PayeeForm
Form SSA-11-BK Request to be Selected as a PayeeForm
Form SSA-11-BK Request to be Selected as PayeeForm
Supporting Statement - 0960-0014.docxSupporting Statement A
Individuals/Households: Paper SSA-11-BK Form
Individuals/Households: Representative Payee System (RPS) Other-Internal Use Screens
State/Local/Tribal Government: RPS Other-Internal Use Screens
State/Local/Tribal Government: Paper SSA-11-BK Form
Private Sector: RPS Other-Internal Screens
Private Sector: Paper SSA-11-BK Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202604-0960-011 Revision of a currently approved collection 2026-04-27
202203-0960-007 Revision of a currently approved collection 2022-06-02 Approved without change
201812-0960-004 Revision of a currently approved collection 2019-03-27 Approved without change
201602-0960-014 Revision of a currently approved collection 2016-05-09 Approved without change
201511-0960-004 No material or nonsubstantive change to a currently approved collection 2015-12-18 Approved without change
201303-0960-005 Revision of a currently approved collection 2013-06-07 Approved without change
201003-0960-009 Revision of a currently approved collection 2010-08-05 Approved without change
200808-0960-009 Revision of a currently approved collection 2009-01-12 Approved with change
200805-0960-015 No material or nonsubstantive change to a currently approved collection 2008-05-19 Approved without change
200608-0960-016 No material or nonsubstantive change to a currently approved collection 2006-09-01 Approved without change
200511-0960-001 Revision of a currently approved collection 2005-11-07 Approved with change
200306-0960-009 Extension without change of a currently approved collection 2003-06-26 Approved without change
200005-0960-003 Extension without change of a currently approved collection 2000-05-01 Approved without change
200002-0960-003 Revision of a currently approved collection 2000-02-03 Approved without change
199802-0960-001 Extension without change of a currently approved collection 1998-02-11 Approved without change
199612-0960-009 Revision of a currently approved collection 1996-12-20 Approved without change
199512-0960-008 Extension without change of a currently approved collection 1995-12-26 Approved without change
199211-0960-004 Extension without change of a currently approved collection 1992-11-27 Approved without change
199011-0960-001 Revision of a currently approved collection 1990-11-09 Approved without change
198812-0960-002 Revision of a currently approved collection 1988-12-19 Approved without change
198803-0960-002 Extension without change of a currently approved collection 1988-03-07 Approved without change
198504-0960-004 Revision of a currently approved collection 1985-04-16 Approved without change
198408-0960-024 No material or nonsubstantive change to a currently approved collection 1984-08-02 Approved with change
198209-0960-007 Revision of a currently approved collection 1982-09-20 Approved without change
198203-0960-005 Revision of a currently approved collection 1982-03-09 Approved without change
198011-0960-004 Revision of a currently approved collection 1980-11-04 Approved without change
197912-0960-001 Revision of a currently approved collection 1979-12-21 Approved without change
197909-0960-005 No material or nonsubstantive change to a currently approved collection 1979-09-28 Approved with change
197906-0960-004 No material or nonsubstantive change to a currently approved collection 1979-06-26 Approved with change
197805-0960-010 Revision of a currently approved collection 1978-05-15 Approved without change
197804-0960-013 No material or nonsubstantive change to a currently approved collection 1978-04-07 Approved with change
197711-0960-010 No material or nonsubstantive change to a currently approved collection 1977-11-30 Approved with change

OMB Details

Individuals/Households: Paper SSA-11-BK

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
FormNameElectronic accessType
Form SSA-11-BKRequest to be Selected as a PayeePaper OnlyForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.