OMB control number
Application to Collect A Fee for Payee Services
OMB 0960-0719 · SSA.
Sections 205(j) and 1631(a) of the Social Security Act allow SSA to authorize certain organizational representative payees to collect a fee for providing payee services. Before an organization may collect this fee, they complete and submit Form SSA-445. SSA uses the information to determine whether to authorize or deny permission to collect fees for payee services. The respondents are private sector businesses, or State and local government offices, applying to become a fee-for-service organizational representative payee.
The latest form for Application to Collect A Fee for Payee Services expires 2027-09-30 and can be found here.
Document Name |
|---|
Form |
Form |
Supporting Statement A |
Form SSA-445 Application to Collect A Fee for Payee Services (State/local government offices)
Supporting Statement - 0719 (Final).docx
Application to Collect A Fee for Payee Services (State/local government offices) |
Approved without change |
Revision of a currently approved collection | 2024-06-21 | |
|
Approved without change |
Revision of a currently approved collection | 2021-01-28 | |
|
Approved without change |
Revision of a currently approved collection | 2017-11-14 | |
|
Approved without change |
Revision of a currently approved collection | 2014-10-06 | |
|
Approved without change |
Revision of a currently approved collection | 2012-01-19 | |
|
Approved without change |
Revision of a currently approved collection | 2009-02-13 | |
|
Approved with change |
New collection (Request for a new OMB Control Number) | 2005-12-27 |
Application to Collect A Fee for Payee Services (State/local government offices)
Federal Enterprise Architecture: Income Security - General Retirement and Disability
| Form SSA-445 | Application to Collect a Fee for Payee Services (State/local government) | Paper Only | Form |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.