Appointment of Representative

ICR 201103-0960-019

OMB: 0960-0527

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Justification for No Material/Nonsubstantive Change
2011-03-21
IC Document Collections
IC ID
Document
Title
Status
9438 Modified
ICR Details
0960-0527 201103-0960-019
Historical Active 201004-0960-006
SSA
Appointment of Representative
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 04/08/2011
Retrieve Notice of Action (NOA) 03/24/2011
  Inventory as of this Action Requested Previously Approved
02/28/2014 02/28/2014 02/28/2014
551,520 0 551,520
91,920 0 91,920
0 0 0

Persons claiming benefits under the Social Security Act must notify SSA in writing when they appoint an individual to represent them in dealings with SSA. SSA collects the information on Form SSA-1696-U4 to verify the appointment of such representatives. The SSA-1696-U4 allows SSA to inform representatives of items affecting the recipient's claim and allows claimants to give permission to their appointed representative to designate a person to copy claims files. Respondents are applicants/recipients of Social Security benefits or Supplemental Security Income payments. This submission is for minor, non-substantive changes to the collection instrument.

US Code: 42 USC 406 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  75 FR 45190 08/02/2010
75 FR 61550 10/05/2010
No

1
IC Title Form No. Form Name
Appointment of Representative SSA-1696-U4 Appointment of Representative

  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 551,520 551,520 0 0 0 0
Annual Time Burden (Hours) 91,920 91,920 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$3,397,363
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/24/2011


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