Supporting Statement - 0730

Supporting Statement for Form SSA-1695

Identifying Information for Possible Direct Payment of Authorized Fees

OMB No. 0960-0730

1. Justification

1. Introduction/Authorizing Laws and Regulation

Pursuant to Sections 206(a) and 1631(d) of the Social Security Act (Act) the Social Security Administration (SSA) collects the information on this form to facilitate direct payment of authorized fees to an attorney or other person who represents claimants for benefits before SSA. SSA also uses the information to meet any requirement to issue a Form 1099-MISC, pursuant to 26 USC 6041 and 26 USC 6045(f) of the United States Code, under the Internal Revenue Service.

2. Description of Collection

SSA collects information from claimants’ appointed representatives on Form

SSA-1695 to: (1) Process and facilitate direct payment of authorized fees; (2) issue a Form 1099–MISC, if applicable; and (3) establish a link between each claim for benefits and the data we collect on the SSA-1699 (OMB Control No. 0960-0732) for our appointed representative database. The respondents are attorneys and other individuals who represent claimants for benefits before SSA.

3. Use of Information Technology to Collect the Information

Form SSA-1695 is available on SSA’s website as a fillable PDF, which representatives can complete, print, and send to SSA. SSA did not create an electronic version of Form SSA-1695 under the agency’s Government Paperwork Elimination Act (GPEA) plan because Form SSA-1695 does not become part of the claims file; after we enter it into the appropriate systems, SSA destroys the form.

4. Why We Cannot Use Duplicate Information

The nature of the information we collect and the manner in which we collect it preclude duplication. SSA does not use another collection instrument to collect similar data.

5. Minimizing Burden on Small Respondents

This collection does not affect small businesses or other small entities.

6. Consequences of Not Collecting Information or Collecting it Less Frequently

SSA does not currently have another process for collecting this information. The information provided by appointed representatives facilitates direct payment of authorized fees in each claim, and meets the requirements to issue a Form

1099-MISC. Therefore, if we did not use Form SSA-1695, we would be unable to meet the requirements to issue a Form 1099-MISC, or to pay authorized fees directly. Because we only collect the information on an as-needed basis, we cannot collect it less frequently.

7. Special Circumstances

There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.

8. Solicitation of Public Comment and Other Consultations with the Public

The 60-day advance Federal Register Notice published on January 12, 2018, at

83 FR 1651, and we received no public comments. The 30-day FRN published on April 3, 2018 at 83 FR 14306. If we receive any comments in response to this Notice, we will forward them to OMB.

9. Payment or Gifts to Respondents

SSA does not provide payments or gifts to the respondents.

10. Assurances of Confidentiality

SSA protects and holds confidential the information we collect in accordance with

42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act),

5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.

11. Justification for Sensitive Questions

The information collection does not contain any questions of a sensitive nature.

12. Estimates of Public Reporting Burden

Modality of Completion	Number of Respondents	Frequency of Response	Number of Responses	Average Burden per Response (minutes)	Estimated Total Annual Burden (hours)
SSA-1695	10,000	40	400,000	10	66,667

The total burden for this ICR is 66,667 hours. This figure represents burden hours based on current management information, and we did not calculate a separate cost burden.

13. Annual Cost Burden to the Respondents (Other)

This collection does not impose a known cost burden to the respondents.

14. Annual Cost To Federal Government

The annual cost to the Federal Government is approximately $100,000. This estimate accounts for costs from the following areas: (1) designing, printing, and distributing the form; and (2) SSA employee (e.g., field office, 800 number, DDS staff) information collection and processing time.

15. Program Changes or Adjustments to the Information Collection Request

There are no changes to the public reporting burden.

16. Plans for Publication Information Collection Results

SSA will not publish the results of the information collection.

17. Displaying the OMB Approval Expiration Date

OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.

18. Exceptions to Certification Statement

SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).

2. Collections of Information Employing Statistical Methods

SSA does not use statistical methods for this information collection.

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