Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration

Forms and Documents

Document Name	Status
Form SSA-1560-U4 Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration Form	Modified
Justification for a Non-Substantive Changes - 0104.doc Justification for No Material/Nonsubstantive Change	2012-09-07

IC Document Collections

IC ID	Document Title	Status
9068	Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration Form	Modified

ICR Details

OMB Control No: 0960-0104	ICR Reference No: 201209-0960-001
Status: Historical Active	Previous ICR Reference No: 201012-0960-004
Agency/Subagency: SSA	Agency Tracking No:
Title: Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/25/2012
	Date Received in OIRA: 09/10/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2014	06/30/2014	06/30/2014
Responses	48,110	0	48,110
Time Burden (Hours)	24,055	0	24,055
Cost Burden (Dollars)	0	0	0

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Abstract: A Social Security claimant's representative, whether an attorney or a non-attorney, uses Form SSA 1560-U4 to petition SSA for authorization to charge and collect a fee. A claimant may also use the form to agree or disagree with the requested fee amount or other information the representative provides on the form. The SSA official responsible for setting the fee uses the information from the form to determine a reasonable fee amount representatives may charge for their services. Respondents are attorneys and non-attorneys who represent claimants for Social Security benefits. This is a Change Request to add new regulatory citations to this information collection request.

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Authorizing Statute(s): US Code: 42 USC 406 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  

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:
	76 FR 3688	01/20/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 17977	03/31/2011
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
Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration	SSA-1560-U4	Petition to Obtain Approval of a Fee for Representing a Claimant Before the Social Security Administration

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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	48,110	48,110	0	0	0	0
Annual Time Burden (Hours)	24,055	24,055	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: $12,509

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]? No

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: 09/10/2012

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