Addendum to the Supporting Statement 0960-0104

Addendum to Supporting Statement.doc

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

Addendum to the Supporting Statement 0960-0104

OMB: 0960-0104

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Addendum to the Supporting Statement for Petition for Authorization to Charge and Collect a Fee for Services before the Social Security Administration

Form SSA-1560-U4

OMB No. 0960-0104 SSA-1560-U4



Revision to the Collection Instrument



  • Change 1: We are changing the title from “PETITION TO OBTAIN APPROVAL OF A FEE FOR REPRESENTING A CLAIMANT BEFORE THE SOCIAL SECURITY ADMINISTRATION” to “PETITION FOR AUTHORIZATION TO CHARGE AND COLLECT A FEE FOR SERVICES BEFORE THE SOCIAL SECURITY ADMINISTRATION.”

Justification 1: We are making this language change for clarification purposes.

  • Change 2: We are changing the language in question #1 from “separate page or pages” to “separate page(s).”

Justification 2: We are making this language change for clarification purposes.

  • Change 3: In question #2, we are removing “to this petition.”

Justification 3: We are making this language change for clarification purposes.

  • Change 4: We are changing the language in question #3 from “If ‘yes’ to either or both of the above, please specify the source(s) and the amount(s).” to “If ‘yes,’ to either or both of the above, please specify the source(s) and amount(s) and attach a copy of proof.”

Justification 4: We are making this language change for clarification purposes.

  • Change 5: We are removing sources listings from Question #3.

Justification 5: We require the representative to add proof to the sources to the form.

  • Change 6: We are changing the language in question #4 from “If ‘yes,’ please itemize your expenses and the amounts on a separate page.” to “If ‘yes,’ please specify the source and itemize your expenses and the amounts on a separate page.”

Justification 6: We are making this language change for clarification purposes.

  • Change 7: We are changing the language in question #5 from “render” to “provide.”

Justification 7: We are making this language change for clarification purposes.



  • Change 8: We are changing the language in question #5 from “Please attach a copy of the court order if the court has approved a fee.” to “Please specify the amount and attach a copy of the court order if the court awarded a fee.

Justification 8: We are making this language change for clarification purposes.

  • Change 9: We are changing the format for field “Name and SSN” of Claimant to separate fields for each entry.

Justification 9: We are making this language change for clarification purposes.

  • Change 10: We are including the representative’s REP ID (Representative’s Identification Number).

Justification 10: We are making this change for clarification purposes and to comply with RASR (Registration, Appointment Services for Representatives).

  • Change 11: We are including the representative’s name.

Justification 11: We are making this change for clarification purposes.

  • Change 12: We are changing the format for the Representative’s contact information to separate fields for each entry.

Justification 2: We are making this language change for clarification purposes.

  • Change 13: We are adding question #8 “Have you provided the claimant with a copy of this fee petition?

Justification 13: We are making this language change for clarification purposes.

  • Change 14: We are changing the format for the Claimant’s contact information to separate fields for each entry.

Justification 14: We are making this language change for clarification purposes.

  • Change 15: We combined the instructions for representative and claimant.

Justification 15: We are making this language change for clarification purposes.



We will start using the new form at the time of OMB approval. We will use the old stock until depleted, since we mostly just revised the form.





File Typeapplication/msword
AuthorMandley, Tasha
Last Modified ByMandley, Tasha
File Modified2017-01-17
File Created2016-12-21

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