Information Collection

Non-Attorney Representative Demonstration Project - Paper Application

IC 191052 under ICR 202005-0960-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form SSA-1691 Non-Attorney Representative Demonstration Project - Paper Application Form and Instruction
SSA-1691 Eligible Non-Attorney Representative SSA-1691 (revised).pdf Form and Instruction
SSA-1691 (current).pdf SSA-1691 - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

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:

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

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 468	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	468	0	268	200
Annual IC Time Burden (Hours)	351	0	201	150
Annual IC Cost Burden (Dollars)	468,000	268,000	0	200,000

Documents for IC

Title	Document	Date Uploaded
SSA-1691 - Current	SSA-1691 (current).pdf	08/26/2020

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