Information Collection

Claimant's Revocation of the Appointment of a Representative - SSA-1696-SUP1

IC 235151 under ICR 201910-0960-001 · OMB 0960-0527.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0527 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1696-SUP1 Claimant's Revocation of the Appointment of a Representative - SSA-1696-SUP1 Form and Instruction
SSA-1696-SUP1 Claimant's Revocation of the Appointment of a Representa SSA-1696-SUP1 - New Form.pdf www.ssa.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Claimant's Revocation of the Appointment of a Representative - SSA-1696-SUP1	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.1507 20 CFR 416.1520 20 CFR 404.1707 20 CFR 404.1720 20 CFR 408.1101

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1696-SUP1	Claimant's Revocation of the Appointment of a Representative	SSA-1696-SUP1 - New Form.pdf	www.ssa.gov	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	21,000	21,000
Annual IC Time Burden (Hours)	1,750	1,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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