Addendum - 0699

Addendum to the Supporting Statement for Form SSA-1691

Application to Participate in the Eligible For Direct Payment Non-Attorney Representative Program

20 CFR 404.1717, 404.1745 - 404.1799, 416.1517, and 416.1545 - 416.1599

OMB No. 0960-0699

Revision to the Collection Instrument

SSA is making the following revision:

• Change #1: We are changing the title of the form on page 1 “Eligible Non-Attorney Representative Application” to “Application to Participate in the Eligible For Direct Payment Non-Attorney Representative Program

Justification #1: We are changing the title of the form to the correct name of the program.

• Change #2: We are revising the instructions to remove unnecessary background information and include instructions for each section of this form.

Justification #2: We revising the language for clarification purposes.

• Change #3: We are revising the format of the instructions from two columns to one column.

Justification #3: We are revising for clarification purposes.

• Change #4: We are moving the Privacy Act Statement from page 9 to page 2. We are also removing the signature requirement for this statement.

Justification #4: We are making this change to conform this form with the format of our other forms.

• Change #5: We are moving the Paperwork Reduction Act Statement from page 9 to page 2. We are also removing the signature requirement for this statement.

Justification #5: We are making this change to conform this form with the format of our other forms.

• Change #6: We are changing the title on page 3 “Section A: Background Information – Applicant’s Identifying Information” and “section A: Background Information – Applicant’s Contact information” and combined both section into to

“Section 1 – Applicant’s Information.

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

• Change #7: We are removing options “Alien Authorized to work in the U.S.” and “Other.”

Justification #7: We are removing, because these options do not apply.

• Change #8: We are removing “Section A: Background Information – Additional Information” and subsequent questions 1 through 2b on page 4.

Justification #8: We are removing section, because question 1 is irrelevant and questions 2a and 2b are a duplicate of information requested in later sections.

• Change #9: We are revising the language and format of “Section A: Background Information - Additional Information (continued) on page 5, and moving it to the new “Section 3 – Disqualification.”

Justification #9: We are making this change for clarification and format purposes.

• Change #10: We are moving “Section B: Education/Equivalent Qualifications – College/University Attended” and “Section B: Education/Equivalent Qualifications – Relevant Professional Experience,” pages 6 and 7, to the new “Section 2 – Educational or equivalent professional work experience information.” on page 4.

Justification #10: We are making this change for clarification and format purposes.

• Change #11: We are changing the title on page 6, Section C: Examination Information” to “Section 4 – Examination location.” We are also moving part of the explanation to the instructions.

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

• Change #12: We are removing “Section D: Additional Information.”

Justification 12: We are making this change since this section is rarely used.

• Change #13: We are changing the format of multiple statements, page 10, and will be collecting these in the new “Section 5 – Acknowledgements and Signature.” Page 6

Justification #13: We are making this change for clarification and format purposes.

• Change #14: We are adding the header “Section 6 – Background check” to the last page.

Justification #14: We are making this change for uniformity.

• Change #15: We are revising the Privacy Act Statement on this form.

Justification #15: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the form.