Information Collection

Non-Attorney Representative Demonstration Project - Paper Application

IC 191052 under ICR 201701-0960-015 · OMB 0960-0699.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0699 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1691 Non-Attorney Representative Demonstration Project - Paper Application	Form and Instruction
Revised PA Statement.pdf	Other-Revised PA Statement
SSA-1691 Eligible Non-Attorney Representative SSA-1691 - Revised.pdf	Form and Instruction
SSA-1691 - Current.pdf SSA-1691 - Current	IC Document

IC Title:

Non-Attorney Representative Demonstration Project - Paper Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.1545 - 416.1599 20 CFR 404.1745 - 404.1799

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1691	Eligible Non-Attorney Representative	SSA-1691 - Revised.pdf		No		Paper Only
Other-Revised PA Statement			Revised PA Statement.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	200,000	200,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-1691 - Current	SSA-1691 - Current.pdf	03/27/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.