Information Collection

Form SSA-1699

IC 43720 under ICR 200906-0960-006 · OMB 0960-0732.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0732 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1699 Form SSA-1699	Form and Instruction
SSA-1699 Registration of Individual for Appointed Representative Form SSA-1699 (Revised).pdf	Form and Instruction
Current Form SSA-1699.pdf Current SSA-1699	IC Document

IC Title:

Form SSA-1699

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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-1699	Registration of Individual for Appointed Representative Services	Form SSA-1699 (Revised).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: 52,800

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	52,800	42,800	10,000
Annual IC Time Burden (Hours)	26,400	23,067	3,333
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-1699	Current Form SSA-1699.pdf	06/30/2009

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