Identifying Information for Possible Direct Payment of Authorized Fees

Identifying Information for Possible Direct Payment of Authorized Fees

OMB: 0960-0730

IC ID: 43718

Information Collection (IC) Details

View Information Collection (IC)

Identifying Information for Possible Direct Payment of Authorized Fees
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-1695 Identifying Information for Possible Direct Payment of Authorized Fees ssa-1695 (revised).pdf No   Paper Only
Other-Revised Privacy Act Statement Privacy Act Statement 0730.doc No   Printable Only
Other-Revised Paperwork Reduction Act PRA 0730.doc No   Printable Only

Income Security General Retirement and Disability

 

10,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 400,000 0 0 0 0 400,000
Annual IC Time Burden (Hours) 66,667 0 0 0 0 66,667
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-1695 Current Version ssa-1695(current).pdf 04/09/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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