Supporting Statement--0527

Supporting Statement for Form SSA-1696-U4

Appointment of Representative

20 CFR 404.1707, 404.1720, 414.1725, 410.684, and 416.1507

OMB No. 0960-0527

A. Justification

1. A person claiming a right or benefit under the Social Security Act (the Act) must notify the Social Security Administration (SSA) in writing if he or she appoints an individual to represent him or her in dealings with SSA. In addition, a representative must also sign the notice of appointment if the representative is not an attorney. The statutory authority for requiring this information is found in Sections 206(a) and 1631(d)(2) of the Act The implementing regulations are found in 20 CFR 404.1707, 410.684, and 416.1507 of the Code of Federal Regulations. Sections 206(a) and 1631(d)(2) of the Act, provide that when the person representing the claimant is an attorney, the Commissioner shall certify payment out of past-due benefits a fee equal to as much as 25 percent of past-due benefits. The implementing regulations are found at 20 CFR 404.1720 and 414.1725.

2. SSA recognizes the claimant’s representative as the person named in a notice of appointment (or written statement) signed by the claimant and filed at an SSA office. The SSA-1696-U4 is used to document the appointment of a representative. In addition, a non-attorney representative must also sign the SSA-1696-U4. SSA has also added a checkbox and statement so that claimants will no longer have the extra burden of completing the SSA-3288 in conjunction with the SSA-1696-F4 in order to release claim-related information to associates, partners and/or parties under contractual arrangements for or with their designated representative. Respondents are representatives of claimants for Social Security benefits.

3. SSA is currently developing an electronic version of Form SSA-1696-U4.  Implementation of this new electronic version is tentatively scheduled for 2009, dependent upon the completion of systems changes. In the interim, a PDF version of the SSA-1696-U4 which allows individuals to print the form, complete it and mail it to SSA for processing, is available on SSA’s website for easy access.

4. The nature of the information being collected and the manner in which it is collected preclude duplication. There is no other collection instrument used by SSA that collects data similar to that collected here.

5. This information collection does not involve small businesses or small entities.

6. If the information identifying each claimant’s representative were not collected, SSA could not fulfill its obligations under the Act and regulations to recognize an attorney or other qualified individual named by a claimant as his or her representative. Therefore, this information collection cannot be conducted less frequently. There are no technical or legal obstacles that prevent burden reduction.

7. There are no special circumstances that would cause this information collection to be conducted in a manner that is not consistent with 5 CFR 1320.5.

8. The 60-day advance Federal Register Notice was published on March 29, 2007 at 72 FR 14845, and SSA has received no public comments. The second Notice was published on June 27, 2007, at 72 FR 35293. There have been no outside consultations with members of the public.

9. SSA provides no payment or gifts to the respondents.

10. The information requested is protected and held confidential in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A‑130.

11. The information collection does not contain any questions of a sensitive nature.

12. Form SSA-1696-U4 is used by approximately 551,520 respondents annually. The estimated average response time is 10 minutes, for a total of 91,920 burden hours. The total burden is reflected as burden hours, and no separate cost burden has been calculated.

13. There is no known cost burden to the respondents.

14. The annual cost to the Federal government is approximately $3,397,363. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.

15. There are no changes in the public reporting burden.

16. The results of the information collection will not be published.

17. OMB has granted SSA an exemption from the requirement that the expiration date for OMB approval be printed on its program forms. SSA produces millions of public‑use forms, many of which have a life cycle longer than that of an OMB clearance. SSA does not periodically revise and reprint its public‑use forms (e.g., on an annual basis). This exemption was granted so that otherwise useable editions of forms would not be taken out of circulation because the expiration date had been reached. In addition, government waste has been avoided because stocks of forms will not have to be destroyed and reprinted.

18. SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b) (3).

B. Collections of Information Employing Statistical Methods

Statistical methods are not used for this information collection.

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