Information Collection

Representative's Withdrawal of Acceptance of an Appointment - SSA-1696-SUP2

IC 235152 under ICR 202005-0960-012 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1696-SUP2 Representative's Withdrawal of Acceptance of an Appointment Representative's Withdrawal of Acceptance of an Appointment - SSA-1696-SUP2	Form and Instruction
SSA-1696-SUP2 Representative's Withdrawal of Acceptance of an Appointm SSA-1696-SUP2 - New Form.pdf	Form and Instruction

IC Title:

Representative's Withdrawal of Acceptance of an Appointment - SSA-1696-SUP2

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

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

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-1696-SUP2			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: 233,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	233,000	233,000
Annual IC Time Burden (Hours)	19,417	19,417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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