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
Supporting Statement - 0730.doc Supporting Statement A	2010-07-14
Addendum - 0730.doc Supplementary Document	2010-06-29

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: 201003-0960-002
Status: Historical Active	Previous ICR Reference No: 200902-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Identifying Information for Possible Direct Payment of Authorized Fees
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/27/2010
	Date Received in OIRA: 07/14/2010
Terms of Clearance: This form is approved for two years only. SSA planned to introduce a new system in Spring 2010, to enable information to be filled out online without requiring social security numbers. When the new system is completed, this form will be discontinued.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2012	36 Months From Approved	08/31/2010
Responses	400,000	0	400,000
Time Burden (Hours)	66,667	0	66,667
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: The Social Security Act
   US Code: 42 USC 1382b Name of Law: The Social Security Act
   US Code: 26 USC 6041 Name of Law: The Internal Revenue Code
   US Code: 26 USC 6045(f) Name of Law: The Internal Revenue Code
  

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:
	75 FR 15761	03/30/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 32231	06/07/2010
Did the Agency receive public comments on this ICR? No

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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	400,000	0	0	0	0
Annual Time Burden (Hours)	66,667	66,667	0	0	0	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:

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Annual Cost to Federal Government: $371,000

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]? No

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: 07/14/2010

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