SSA-623: Representative Payee Report (Adult Beneficiaries)

Representative Payee Report (Adult, Child, and Organizational Representative Payee)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0068 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-623 SSA-623: Representative Payee Report (Adult Beneficiaries) Form
Rep_Payee_Insert[1].pdf Other-Information Insert for Paper F
Revised PA and PRA Statements.pdf Other-Revised PA and PRA Statements
SSA-623 Representative Payee Report (Adult) SSA-623-F6 - Revised.pdf Form

Information Collection (IC) Details

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	Available Electronically?	Electronic Capability
Form	SSA-623	Representative Payee Report (Adult)	SSA-623-F6 - Revised.pdf	No	Fillable Printable
Other-Information Insert for Paper Forms Re New Internet Option			Rep_Payee_Insert[1].pdf	No	Paper Only
Other-Revised PA and PRA Statements			Revised PA and PRA Statements.pdf	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,155,574	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	Previously Approved
Annual Number of Responses for this IC	2,155,574	-657,088	2,812,662
Annual IC Time Burden (Hours)	538,894	-164,272	703,166
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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