Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Application for Substitution of Payee and Duties As Representative Payee (Individuals) Modified 13725 12112 0 Form AA-5
Form and Instruction RB-5
Application for Substitution of Payee and Duties as Representative Payee (Institutions) New 4575 4038 0 Form and Instruction AA-5
Form and Instruction RB-5
Statement Regarding Patient's Capability to Manage Payments New 2000 200 0 Form and Instruction G-478
Total burden requested under this ICR: 20300 16350 0  
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