Registration for Appointed Representative Services and Direct Payment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-1699 Registration for Appointed Representative Services and Direct Payment	Form and Instruction	Modified	Available
Form SSA-1699 Form SSA-1699	Form and Instruction	Modified	Repair queued
Supporting Statement - 0732 (Revised).docx	Supporting Statement A	Uploaded 2024-09-20	Available
Supporting Statement - 0732 (Final).docx	Supporting Statement A	Uploaded 2021-11-18	Repair queued
Addendum - 0732 (final).docx	Supplementary Document	Uploaded 2021-11-18	Available
Addendum - 0732 (final).docx	Supplementary Document	Uploaded 2021-11-18	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43720	Form SSA-1699	Form and Instruction	Modified	Registration for Appointed Representative Services and Direct Payment
43720	Form SSA-1699	Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0732	ICR Reference No: 202108-0960-007
Status: Active	Previous ICR Reference No: 201903-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Registration for Appointed Representative Services and Direct Payment
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/20/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/18/2021
Terms of Clearance: The agency modified the supporting statement to provide greater detail regarding how this information collection is related to other ones commonly filed by appointed representative (the 169X series). Prior to triannual renewal, the agency should evaluate how it can accommodate fully electronic completion and submission of this information collection consistent with with the agency's commitments under Sec. 4 (k)(iii) and (iv) of E.O. 14058.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2027	36 Months From Approved	09/30/2024
Responses	10,382	0	17,700
Time Burden (Hours)	3,461	0	5,900
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses Form SSA-1699 to register appointed representatives of claimants before SSA who: • Want to register for direct payment of fees; • Registered for direct payment of fees prior to 10/31/09, but need to update their information; • Registered as appointed representatives on or after 10/31/09, but need to update their information; or • Received a notice from SSA instructing them to complete this form. By registering these individuals, SSA: (1) authenticates and authorizes them to do business with us; (2) allows them to access our records for the claimants they represent; (3) facilitates direct payment of authorized fees to appointed representatives; and, (4) collects the information we need to meet Internal Revenue Service (IRS) requirements to issue specific IRS forms if we pay an appointed representative in excess of a specific amount ($600). The respondents are appointed representatives who want to use Form SSA-1699 for any of the purposes cited above.

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Authorizing Statute(s): US Code: 42 USC 406 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 46897	08/20/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 64585	11/18/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Form SSA-1699	SSA-1699	Registration for Appointed Representative Services and Direct Payment

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	10,382	17,700	0	0	-7,318	0
Annual Time Burden (Hours)	3,461	5,900	0	0	-2,439	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2019, the burden was 5,900 hours. However, we are currently reporting a burden of 3,460 hours. This change stems from a decrease in the number of average responses from 17,700 to 10,382. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change.

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Annual Cost to Federal Government: $192,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/18/2021

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