Social Security Administration Eligible Non-Attorney Representative

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-1691 Non-Attorney Representative Demonstration Project - Paper Application	Form and Instruction	Modified	Available
Addendum - 0699.docx	Supplementary Document	Uploaded 2017-05-08	Repair queued
Supporting Statement - 0699.docx	Supporting Statement A	Uploaded 2017-05-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
46659	New and Existing Respondents - Continuing Education Submission		Unchanged
195351	New and Existing Respondents - Written Protests		Unchanged
195350	New and Existing Respondents - Proof of Continuous Professional of Business Liability Insurance Coverage (paper)		Unchanged
195349	New and Existing Respondents - Proof of Continuous Professional or Business Liability Insurance Coverage (electronic)		Unchanged
195348	New Respondent - Submission of Proof of Bachelor's Degree (or Equivalent)		Unchanged
195347	New Respondents Examination		Unchanged
191052	Non-Attorney Representative Demonstration Project - Paper Application	Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0699	ICR Reference No: 201701-0960-015
Status: Active	Previous ICR Reference No: 201402-0960-009
Agency/Subagency: SSA	Agency Tracking No:
Title: Social Security Administration Eligible Non-Attorney Representative
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/29/2017
	Date Received in OIRA: 05/17/2017
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2020	36 Months From Approved	09/30/2017
Responses	2,065	0	2,065
Time Burden (Hours)	976	0	976
Cost Burden (Dollars)	200,000	0	200,000

---

Abstract: Section 3 of the Social Security Disability Applicants Access to Professional Representation Act (PRA) of 2010, Public Law (Pub.L.) 111-142, enacted on February 27, 2010 permanently extends the direct payment provision of Section 303 of the Social Security Protection Act (SSPA) of 2004, Pub.L. 108-203. The PRA permits the Social Security Administration (SSA) to extend direct payment of approved fees from claimants' past-due benefits to certain non-attorney representatives. The PRA, as did the SSPA, requires us to collect the information needed to determine if applicants have satisfied the prerequisites. Under the SSPA, we used the Social Security Administration Non-Attorney Representative Demonstration Project Application to collect applicants' prerequisite information. We are revising the application to comply with the PRA and the Revisions to Direct Fee Payment Rules (RIN 0960-AH21). To help us determine whether an applicant has fulfilled the statutory prerequisites and regulatory requirements of the PRA, we collect the following items from applicants: 1) A signed criminal background form, from all applicants, that allows us to conduct criminal background checks; 2) the examination document and score for applicants who take the examination, 3) professional or business liability insurance policies from applicants who pass the examination; 4) official college transcripts from applicants who pass the examination and possess a bachelor's degree or higher (high school transcripts, diplomas, or GED certificates and proof (e.g., Internal Revenue Service Form W-2(s) and wage and tax statement(s)) of relevant professional experience from applicants who pass the examination, but do not possess a bachelor's degree or higher) 5) email messages, from eligible non-attorneys, that certify the completion of a required continuing education course. We require applicants to submit their application forms directly to a contractor we hired to assist with the management of the prerequisites for direct payment. Every year, the contractor evaluates the applications, conducts verification investigations, and issues recommendations to us regarding applicants' eligibility to sit for the examination and eligibility to receive direct payment. The respondents are non-attorneys who want to receive direct payment of their fees for representational services before SSA.

---

Authorizing Statute(s): PL: Pub.L. 111 - 142 3 Name of Law: Social Security Disability Applicants Access to Professional Representation Act of 2010
   PL: Pub.L. 108 - 203 205 and 303 Name of Law: Social Security Protection Act of 2004
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 11293	02/21/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 21291	05/05/2017
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
New Respondent - Submission of Proof of Bachelor's Degree (or Equivalent)
New and Existing Respondents - Proof of Continuous Professional of Business Liability Insurance Coverage (paper)
New and Existing Respondents - Written Protests
New and Existing Respondents - Continuing Education Submission
Non-Attorney Representative Demonstration Project - Paper Application	SSA-1691	Eligible Non-Attorney Representative
New Respondents Examination
New and Existing Respondents - Proof of Continuous Professional or Business Liability Insurance Coverage (electronic)

---

ICR Summary of Burden

table that charts list 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	2,065	2,065	0	0	0	0
Annual Time Burden (Hours)	976	976	0	0	0	0
Annual Cost Burden (Dollars)	200,000	200,000	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:

---

Annual Cost to Federal Government: $200,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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

---

Common Form ICR:  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:

(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: 05/17/2017

---