View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0960-0069
ICR Reference No:
202204-0960-005
Status:
Active
Previous ICR Reference No:
201904-0960-003
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Representative Payee Evaluation Report
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
04/19/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/03/2022
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2026
36 Months From Approved
04/30/2023
Responses
6,838
0
7,276
Time Burden (Hours)
9,246
0
3,638
Cost Burden (Dollars)
0
0
0
Abstract:
SSA uses the Representative Payee Evaluation Report, Form SSA-624-F5, as a documentation tool for interviews with, and evaluations of, representative payees. SSA requires our field offices (FO) to conduct a face-to-face interview with the representative payee using Form SSA-624-F5 when: (1) SSA finds the payee’s responses on SSA-required annual accounting reports [Forms SSA-623, SSA 6230, and SSA-6234 (OMB No. 0960 0068)] unacceptable, and we cannot resolve them; (2) the payee fails to complete SSA’s initial and second request for an annual accounting report; or (3) assessing the representative payee’s continued suitability. In addition to the representative payee, we also interview the beneficiary or SSI recipient, and custodian (if other than the payee) to confirm information the payee provides, and to ensure the payee is meeting the beneficiary’s or SSI recipient’s current needs (face to-face interview not required). The respondents are individuals or organizations serving as representative payees for individuals receiving Title II benefits or Title XVI payments who fail to comply with SSA’s statutory annual reporting requirement, SSA beneficiaries or recipients, and third-party custodians.
Authorizing Statute(s):
US Code:
42 USC 405
Name of Law: Social Security Act
US Code:
42 USC 1383
Name of Law: Social Security Act
Citations for New Statutory Requirements:
PL: Pub.L. 115 - 165 102 Name of Law: Strengthening Protections for Social Security Benefits Act of 2018
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
87 FR 39153
06/30/2022
30-day Notice:
Federal Register Citation:
Citation Date:
87 FR 57551
09/20/2022
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Representative Payee Evaluation Report--Individuals/Households
SSA-624-F5
Representative Payee Evaluation Report
Representative Payee Evaluation Report--Private Sector
SSA-624-F5
Representative Payee Evaluation Report
Representative Payee Evaluation Report--State/Local Government
SSA-624-F5
Representative Payee Evaluation Report
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
6,838
7,276
0
0
-438
0
Annual Time Burden (Hours)
9,246
3,638
0
0
5,608
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
When we last cleared this IC in 2019, the burden was 3,638 hours. However, we are currently reporting a burden of 3,420 hours. This change stems from a decrease in the number of responses from 7,276 to 6,838. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data. Note: The total burden reflected in ROCIS is 9,246, while the burden cited in #12 of the Supporting Statement is 3,420. This discrepancy is because the ROCIS burden reflects the following components: field office and teleservice center waiting times + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.
Annual Cost to Federal Government:
$116,657
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
No
Agency Contact:
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
10/03/2022
An official website of the United States government
The .gov means it's official.
The site is secure.
