Information Collection

Non-Attorney Representative Demonstration Project --Application

IC 9753 under ICR 201011-0960-010 · OMB 0960-0699.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0699 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Online Application Final.pdf www.cps.ca.gov/tlc/ssa/howtoapply.asp	Other-Online Collection Screens

IC Title:

Non-Attorney Representative Demonstration Project --Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.1545-416.1599 20 CFR 404.1745-404.1799

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
Other-Online Collection Screens			Online Application Final.pdf	http://www.cps.ca.gov/tlc/ssa/howtoapply.asp	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 180

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-180	180
Annual IC Time Burden (Hours)	-180	180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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