I4547 (internet version)

Advance Designation of Representative Payee

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0814 can be found here:

Documents and Forms

Document Name Document Type
iClaim Advance Designation of Representative Payee Screen Package.pdf Other-iClaim Internet Screens
iClaim Advance Designation of Representative Payee Screen Package.pdf Other-iClaim Internet Screens
mySSA Advance Designation of Representative Payee Screen Package_9.26 Alternative V1.3.pdf Other-mySSA Internet Screens
mySSA Advance Designation of Representative Payee Screen Package_9.26 Alternative V1.3.pdf Other-mySSA Internet Screens
Advance Designation of Representative Payee Annual Notice (revised).pdf Other-Annual Notice
Advance Designation of Representative Payee Annual Notice (revised).pdf Other-Annual Notice
Advance Designation of Represenative Payee Receipts (revised).pdf Other-Payee Receipts
Advance Designation of Represenative Payee Receipts (revised).pdf Other-Payee Receipts
Advance Designation of Representative Payee Annual Notice (current).pdf Annual Notice IC Document
Advance Designation of Representative Payee Annual Notice (current).pdf Annual Notice IC Document
Advance Designation of Represenative Payee Receipts (current).pdf Payee Receipts IC Document
Advance Designation of Represenative Payee Receipts (current).pdf Payee Receipts IC Document

Information Collection (IC) Details

IC Title:	I4547 (internet version)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-iClaim Internet Screens	iClaim Advance Designation of Representative Payee Screen Package.pdf	Yes	Yes	Fillable Fileable Signable
Other-mySSA Internet Screens	mySSA Advance Designation of Representative Payee Screen Package_9.26 Alternative V1.3.pdf	Yes	Yes	Fillable Fileable Signable
Other-Annual Notice	Advance Designation of Representative Payee Annual Notice (revised).pdf	Yes	No	Paper Only
Other-Payee Receipts	Advance Designation of Represenative Payee Receipts (revised).pdf	Yes	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,201,466	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,201,466	3,201,466
Annual IC Time Burden (Hours)	320,147	320,147
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Annual Notice	Advance Designation of Representative Payee Annual Notice (current).pdf	08/24/2021
Payee Receipts	Advance Designation of Represenative Payee Receipts (current).pdf	08/24/2021

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