Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration

ICR 200412-0960-004

OMB: 0960-0104

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0960-0104 200412-0960-004
Historical Active 200409-0960-004
SSA
Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration
Revision of a currently approved collection   No
Emergency 01/10/2005
Approved without change 12/21/2004
Retrieve Notice of Action (NOA) 12/10/2004
  Inventory as of this Action Requested Previously Approved
06/30/2005 06/30/2005 01/31/2007
34,624 0 269,000
17,312 0 134,500
0 0 0

Form SSA-1560-U4 is used by SSA if the representative files a fee petition to obtain approval of a fee for representing a claimant. The representative must file in order to charge for representing a claimant in proceedings before the Agency. The information is reviewed by SSA to determine a reasonable fee for the representative's services. A claimant may also use the form to disagree about the fee amount. The respondents are claimants, attorneys, and other persons representing Social Security claimants.

None
None


No

1
IC Title Form No. Form Name
Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration SSA-1560-U4

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 34,624 269,000 0 0 -234,376 0
Annual Time Burden (Hours) 17,312 134,500 0 0 -117,188 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/10/2004


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