Advance Designation of Representative Payee (Intranet Version - Paper Form SSA-4547)

SCREEN PACKAGE DOCUMENT
SECTION 201, ADVANCE DESIGNATION OF
REPRESENTATIVE PAYEE INTRANET

Screen Package Document – Advance Designation of Representative Payee Intranet

Table of Contents
1.

Screen Package Document Version Information ........................................................................................................ 3

2.

Screen Designs and Component Descriptions ............................................................................................................ 4

2.1.

Emancipated Minors ................................................................................................................................................... 4

2.2.

Adding Designees ........................................................................................................................................................ 7

2.3.

Reviewing Advance Designation ............................................................................................................................... 11

2.4.

Search........................................................................................................................................................................ 15

2.5.

Document Contact .................................................................................................................................................... 16

3.

Appendix A - UXG Contact Information for Analysts, Developers and Others ......................................................... 20

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Screen Package Document – Advance Designation of Representative Payee Intranet

1. Screen Package Document Version Information
The first release of this document as a project deliverable is numbered 1.0.
Subsequent revisions are numbered 1.1, 1.2, 1.3, etc. Content revisions are listed below with corresponding page
numbers.
Version
Number

Date

Content Revisions

Page
#

Revised by

1.0

September 25,
2019

Author of initial release and all revisions – Yulia Wentling and Kai Wong

N/A

N/A

1.1

July 21, 2021

Removed the notification instructing staff to print receipts locally due to
sending all receipt printing jobs to the central printing office.

8 and 11

Yulia Wentling

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Screen Package Document – Advance Designation of Representative Payee Intranet

2. Screen Designs and Component Descriptions
2.1.

Emancipated Minors

If the applicant/beneficiary is under age 18, the SSA technician must first ask if they are an emancipated minor.

If the applicant/beneficiary is an emancipated minor, then the SSA technician must ask for proof.

If a minor is not emancipated or cannot provide proof of emancipation, they may not advance designate.

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Screen Package Document – Advance Designation of Representative Payee Intranet

Emancipated minors with proof of emancipation will have the option to advance designate.

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Screen Package Document – Advance Designation of Representative Payee Intranet

Help links allow SSA technicians to look up definitions as well as policy references.

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Screen Package Document – Advance Designation of Representative Payee Intranet

2.2.

Adding Designees

Applicants/beneficiaries age 18 or over and emancipated minors with proof are eligible to advance designate.

An SSA technician can review information with the applicant/beneficiary about advance designation of a representative
payee by selecting “Show information about advance designation.”

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Screen Package Document – Advance Designation of Representative Payee Intranet

If the applicant/beneficiary decides not to advance designate at this time, the SSA technician can explain how to go
through this process at a later time.
When the SSA technician selects “Next,” a receipt that confirms the applicant/beneficiary declined to advance designate
at this time will be sent automatically to the central print. The receipt includes the Privacy Act and Paperwork Reduction
Act.

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Screen Package Document – Advance Designation of Representative Payee Intranet

If the applicant/beneficiary decides to advance designate, the page will display a table where the SSA technician can add
a designee.

The help link explains the term Order of Priority.

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Screen Package Document – Advance Designation of Representative Payee Intranet

The “Add Designee” button brings up a lightbox where the SSA technician can enter the advance designee’s information.

Providing the relationship is optional, but a response is required in the “Relationship” field. “No response” is the option
the SSA technician selects when the applicant/beneficiary does not want to provide the relationship. When the SSA
technician selects “Other” from Relationship dropdown, they must enter a relationship.

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Screen Package Document – Advance Designation of Representative Payee Intranet

2.3.

Reviewing Advance Designation

After an applicant/beneficiary provides an advance designation, the Advance Designation page displays the list of
advance designees. When the SSA technician selects “Next,” a receipt that confirms the applicant/beneficiary’s advance
designation will be sent automatically to the central print. The receipt includes the Privacy Act and Paperwork
Reduction Act.
From here, the SSA technician can update the designee information, delete one or all designees, and change the order
of priority. When the SSA technician makes any changes and selects “Next,” a receipt that confirms the
applicant/beneficiary’s advance designation changes will be sent automatically to the central print. The receipt includes
the Privacy Act and Paperwork Reduction Act.

To update a designee’s information, the SSA technician selects the “Edit” button.

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Screen Package Document – Advance Designation of Representative Payee Intranet

After selecting the “Edit” button, a lightbox displays with the designee’s “Name”, “Phone”, and “Relationship” pre-filled.

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Screen Package Document – Advance Designation of Representative Payee Intranet

To change the order of priority, the SSA technician selects the “Change Order of Priority” button.

To delete a designee, the SSA technician selects the “Delete” button. The following confirmation message displays.

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Screen Package Document – Advance Designation of Representative Payee Intranet

To delete all designees at once, the SSA technician selects the “Delete All” button. The following confirmation message
displays.

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Screen Package Document – Advance Designation of Representative Payee Intranet

2.4.

Search

The SSA technician can search the application from iMain to look up an applicant’s/beneficiary’s advance designees.

Upon entering a valid SSN, the Search Results displays the applicant’s/beneficiary’s information.
If the applicant/beneficiary has advance designees on record, the Search Results table displays the “Select” and
“Document Contact” action buttons.

If the applicant/beneficiary does not have advance designees on record, the Search Results table displays only the
“Select” action button.

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Screen Package Document – Advance Designation of Representative Payee Intranet

2.5.

Document Contact

An SSA technician can access the Document Contact page from the Search Results page by selecting the “Document
Contact” button.

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Screen Package Document – Advance Designation of Representative Payee Intranet

The SSA technician can document their contact(s) with a designee or beneficiary by selecting the “Document Contact”
button within the Contact History. The comments made by when looking to identify a potential representative payees
are viewable within the Contact History.

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Screen Package Document – Advance Designation of Representative Payee Intranet

The sequence of screens below indicates documenting contacts with advance designees.

The “Save” button captures the details of contacting the advance designee under Contact History.

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Screen Package Document – Advance Designation of Representative Payee Intranet

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Screen Package Document – Advance Designation of Representative Payee Intranet

3. Appendix A - UXG Contact Information for Analysts, Developers and Others
For information about any of the content included in this design specifications document, contact the User Experience
(UX) Lead for this product.
Name

Product Role

Email

Phone

Dave Bell

UXG Technical
Advisor

David.Bell@ssa.gov

(410) 966-4248

Yulia Wentling

UX Lead

Yulia.Wentling@ssa.gov

(410) 265-4607

Kai Wong

UX Designer

Christopher.K.Wong@ssa.gov

(410) 265-4690

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Specialized Project
Knowledge

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SSA will insert the following revised Privacy Act & PRA Statements into the
form as soon as possible:
Privacy Act Statement
Collection and Use of Personal Information

Section 205(j) of the Social Security Act, as amended, allows us to collect this
information. Furnishing us this information is voluntary. However, failing to provide all or part
of the information may prevent us from selecting the representative payee(s) you designate to act
on your behalf.
We will use the information you provide to update and maintain your representative payee(s).
We may also share the information for the following purposes, called routine uses:
•

To third party contacts, where necessary, to establish or verify information provided
by representative payees or representative payee applicants; and

•

To contractors and other Federal Agencies, as necessary, for the purpose of assisting
us in the efficient administration of our programs. We will disclose information
under this routine use only in situations in which we may enter into a contractual or
similar agreement to obtain assistance in accomplishing an SSA function relating to
this system or records.

In addition, we may share this information in accordance with the Privacy Act and other Federal
laws. For example, where authorized, we may use and disclose this information in computer
matching programs, in which our records are compared with other records to establish or verify a
person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent
debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice(s)
(SORN) 60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on
October 31, 2019, at 84 FR 58422. Additional information, and a full listing of all our SORNs,
is available on our website at www.ssa.gov/privacy.

Paperwork Reduction Act Statement - This information collection meets the requirements of
44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not
need to answer these questions unless we display a valid Office of Management and Budget
(OMB) control number. We estimate that it will take about 6 minutes to read the instructions,
gather the facts, and answer the questions. Send only comments regarding this burden estimate
or any other aspect of this collection, including suggestions for reducing this burden to: SSA,
6401 Security Blvd, Baltimore, MD 21235-6401.