State/Local/Tribal Government: RPS

Request to be Selected as a Payee

Documents and Forms

Document Name Document Type
eRPS screen for SSA-11 (Revised).pdf Other-Internal Use Screens
eRPS screen for SSA-11 (Revised).pdf Other-Internal Use Screens

Information Collection (IC) Details

IC Title:	State/Local/Tribal Government: RPS	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 404.2010-404.2055 20 CFR 416.601-416.655

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internal Use Screens			eRPS screen for SSA-11 (Revised).pdf		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 19,570	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	19,570	570	19,000
Annual IC Time Burden (Hours)	20,549	16,749	3,800
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.