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OMB Control No: 0960-0576	ICR Reference No: 202408-0960-004
Status: Received in OIRA	Previous ICR Reference No: 202406-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: Representative Payee Report of Benefits and Dedicated Account
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 12/16/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2026
Responses	6,800	6,800
Time Burden (Hours)	5,213	1,700
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	6,800	6,800	0
Annual Time Burden (Hours)	5,213	1,700	3,513
Annual Cost Burden (Dollars)	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: There are no changes to the public reporting burden. * Note: The total burden reflected in ROCIS is 5213, while the burden cited in #12 of the Supporting Statement is 17,000. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

Annual Cost to Federal Government: $488,515

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