Application to Act as Representative Payee

OMB 3220-0052

Under Section 12 of the Railroad Retirement Act, the Railroad Retirement Board (RRB) may pay benefits to a representative payee when an employee, spouse or survivor annuitant is incompetent or is a minor. The collection obtains information related to the representative payee application, supporting documentation and the maintenance of records pertaining to the receipt and use of benefits.

The latest form for Application to Act as Representative Payee expires 2023-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form AA-5 Application for Substitution of Payee and Duties As Representative Payee (Individuals) Form
Form G-478 Statement Regarding Patient's Capability to Manage Payments Form and Instruction
Form AA-5 Application for Substitution of Payee and Duties as Representative Payee (Institutions) Form and Instruction
3220-0052.docx Supporting Statement A
Application for Substitution of Payee and Duties As Representative Payee (Individuals) Form
Statement Regarding Patient's Capability to Manage Payments Form and Instruction
Application for Substitution of Payee and Duties as Representative Payee (Institutions) Form and Instruction

All Historical Document Collections

202303-3220-001 Approved without change	Revision of a currently approved collection	2023-03-28
201912-3220-003 Approved without change	Extension without change of a currently approved collection	2019-12-30
201608-3220-001 Approved without change	Revision of a currently approved collection	2016-10-26
201308-3220-001 Approved without change	Revision of a currently approved collection	2013-08-12
201006-3220-001 Approved without change	Extension without change of a currently approved collection	2010-07-19
200703-3220-003 Approved without change	Revision of a currently approved collection	2007-04-27
200403-3220-003 Approved without change	Extension without change of a currently approved collection	2004-03-25
200102-3220-001 Approved without change	Revision of a currently approved collection	2001-02-06
199711-3220-001 Approved without change	Extension without change of a currently approved collection	1997-11-04
199409-3220-001 Approved without change	Extension without change of a currently approved collection	1994-09-28
199106-3220-002 Approved with change	No material or nonsubstantive change to a currently approved collection	1991-06-24
199106-3220-001 Approved without change	Revision of a currently approved collection	1991-06-28
198802-3220-003 Approved without change	Revision of a currently approved collection	1988-02-23
198709-3220-002 Approved without change	Revision of a currently approved collection	1987-09-28
198609-3220-005 Approved with change	No material or nonsubstantive change to a currently approved collection	1986-09-30
198410-3220-003 Approved without change	Revision of a currently approved collection	1984-10-26
198107-3220-004 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-07-28
198105-3220-028 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-05-28
198103-3220-001 Approved without change	Revision of a currently approved collection	1981-03-04
198003-3220-004 Approved without change	Revision of a currently approved collection	1980-03-18
197502-3220-007 Approved with change	No material or nonsubstantive change to a currently approved collection	1975-02-21
197502-3220-001 Approved without change	Extension without change of a currently approved collection	1975-02-10

OMB Details

Application for Substitution of Payee and Duties As Representative Payee (Individuals)

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form AA-5	Application for Substitution of Payee	Paper Only	Form
Form RB-5	RB-5 Booklet; Your Duties as Representative Payee - Representative Payee's Record	Paper Only	Form and instruction

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