Information Collection

Appointment of Representative - 20 CFR 404 Subpart R, 410 Subpart F and 416 Subpart O

IC 9435 under ICR 200306-0960-007 · OMB 0960-0527.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0527 can be found here:

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Information Collection (IC) Details

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IC Title:	Appointment of Representative - 20 CFR 404 Subpart R, 410 Subpart F and 416 Subpart O	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-1696-U4				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 551,520	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	551,520	138,867	412,653
Annual IC Time Burden (Hours)	91,920	23,144	68,776
Annual IC Cost Burden (Dollars)	0	0	0

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Title	Document	Date Uploaded

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