Identifying Information for Possible Direct Payment of Authorized Fees

Forms and Documents

Document Name	Status
Form SSA-1695 Identifying Information for Possible Direct Payment of Authorized Fees Form and Instruction	Modified
addendum to supporting statement.doc Supplementary Document	2009-04-16
Revised Supporting Statement--SSA-1695 REVISED[1].doc Supporting Statement A	2009-05-28

IC Document Collections

IC ID	Document Title	Status
43718	Identifying Information for Possible Direct Payment of Authorized Fees Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0730	ICR Reference No: 200902-0960-003
Status: Historical Active	Previous ICR Reference No: 200607-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Identifying Information for Possible Direct Payment of Authorized Fees
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/09/2009
	Date Received in OIRA: 06/01/2009
Terms of Clearance: This form is approved for one year only. SSA plan to introduce a new system from Spring 2010, which will enable information to be filled out online and will not require respondents to provide their social security number. This form will be discontinued at that point.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2010	36 Months From Approved	08/31/2009
Responses	400,000	0	250,000
Time Burden (Hours)	66,667	0	41,667
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses Form SSA-1695 to collect information from appointed representatives that will be used to process and facilitate direct payment to a financial institution of authorized fees in each claim. This information will also be used to meet any requirement for issuance of a Form 1099-MISC. The respondents are attorneys and other individuals who represent claimants for benefits before SSA.

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Authorizing Statute(s): US Code: 42 USC 406 Name of Law: Social Security Act
   US Code: 42 USC 1382b Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 8607	02/25/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 19261	04/28/2009
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Identifying Information for Possible Direct Payment of Authorized Fees	SSA-1695	Identifying Information for Possible Direct Payment of Authorized Fees

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ICR Summary of Burden

	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	400,000	250,000	0	0	150,000	0
Annual Time Burden (Hours)	66,667	41,667	0	0	25,000	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The public reporting burden hours increased from 41,667 to 66,667, and the number of respondents increased from 250,000 to 400,000. This increase of burden hours is because each claim for direct fee payment has a SSA-1695 completed, and rapid growth of representation workload.

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Annual Cost to Federal Government: $4,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 06/01/2009

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