Information Collection

Identifying Information for Possible Direct Payment of Authorized Fees

IC 43718 under ICR 200902-0960-003 · OMB 0960-0730.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0730 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1695 Identifying Information for Possible Direct Payment of Authorized Fees	Form and Instruction
SSA-1695 Identifying Information for Possible Direct Payment of A ssa-1695.pdf	Form and Instruction
E6-11784 SORN.pdf SORN	IC Document

IC Title:

Identifying Information for Possible Direct Payment of Authorized Fees

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1695	Identifying Information for Possible Direct Payment of Authorized Fees	ssa-1695.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	400,000	150,000	250,000
Annual IC Time Burden (Hours)	66,667	25,000	41,667
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SORN	E6-11784 SORN.pdf	04/29/2009

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