Addendum to the Supporting Statement 0960-0527

Addendum to the Supporting Statement for

Form SSA-1696-U4

Appointment of Representative

20 CFR 404.1707, 404.1720, 408.1101, 416.1507, and 416.1520

OMB No. 0960-0527

Revisions to the Collection Instrument

Section 1101 of the Social Security Protection Act (SSPA, P.L. 108-203) defines “person” as an individual but also as an entity, business or corporation. Because in our new rules we further defined “entity” in 20 CFR 404.1703 and 20 CFR 416.1503, to avoid confusion, we eliminated any references to the word “person” on the form. In our last revision, we missed two references in Part I of the form. We are now correcting for consistency.

In 2013, we changed the name of our specific URL on our national website that speaks on issues of representation. We are updating the form to reflect that. We made some other changes that we believe will improve readability and clarity across the form.

In “References,” we added the appropriate regulatory reference for Special Veterans Benefits (title VIII).

We are instructing our offices to retain and use prior versions of the form because the revisions to this version of the form are minor.

Revisions to Form SSA-1696-U4:

Part I

We changed the caption to “Claimant’s Appointment of Representative” to indicate the completer.

We replace the word “person” with “individual” for consistency.

We rearranged the check boxes indicating the type of the claim to save space.

We replaced the word “main” with the word “principal” for consistency.

Part II

We changed the caption to “Representative’s Acceptance of Appointment” to indicate the completer.

Part III

We made some minor changes such as completing the introductory verbs in the selection boxes and adding positive language in the second selection box in place of the corresponding negative language in the third box. We added “entity or government agency” to better distinguish the third fee option from the second.

COMPLETING THIS FORM TO APPOINT A REPRESENTATIVE

Throughout the section, we made changes to conform to corresponding caption changes on the form.

In the section “Claimant’s Appointment of Representative,” we deleted “entity,” because that term has a unique connotation for claimant representatives.

We replaced the word “main” with “principal” to conform to changes on the form. We added a brief explanation of the principal representative’s responsibilities.

In section “How to Complete this Form”, we corrected a typo, title XVIII (SVB) to title VIII (SVB).

INFORMATION FOR REPRESENTATIVES

In the section “Fees for Representation” we added “or” in the second bullet for accuracy.

In the sections “Collecting a Fee” and “Registering for Direct Payment,” we updated the name of our website from “Attorneys and Other Appointed Representatives” to “Representing Social Security Claimants” that can be found at www.ssa.gov/representation/.

In the section “Conflict of Interest and Penalties,” we eliminated a bullet, to correct a typo. We also added a missing reference to 20 CFR 408.1101.

Other Minor Revisions to the Collection Instrument

SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the form.

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