View Information Collection (IC)

View Information Collection (IC)

IC Title:	SSA-623: Representative Payee Report (Adult Beneficiaries)	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 404.2065 20 CFR 416.665 20 CFR 404.635 20 CFR 404.2035

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-623	Representative Payee Report (Adult)	SSA-623-OCR-SM (revised).pdf		No		Paper Only
Instruction			T2 FORM SSA-623-OCR-SM (02-2012) - 1ST_opt.pdf		No		Paper Only
Other-Online flyer			Rep_Payee_Insert[1].pdf		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,811,819	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	2,811,819	0	0	433,419	0	2,378,400
Annual IC Time Burden (Hours)	702,955	0	0	108,355	0	594,600
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-623	SSA-623-OCR-SM.PDF	06/24/2014

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