Information Collection

Form SSA-1699

IC 43720 under ICR 202108-0960-007 · OMB 0960-0732.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1699 Form SSA-1699	Form and Instruction
Form SSA-1699 Registration for Appointed Representative Services and Direct Payment Form SSA-1699	Form and Instruction
SSA-1699 Registration for Appointed Representative Services and D SSA-1699 (revised).pdf	Form and Instruction
SSA-1699 Registration for Appointed Representative Services and D SSA-1699 (revised).pdf	Form and Instruction
SSA-1699 (current).pdf SSA-1699 - Current	IC Document
SSA-1699 (current).pdf SSA-1699 - Current	IC Document

IC Title:

Form SSA-1699

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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-1699				No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,382

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10,382	-7,318	17,700
Annual IC Time Burden (Hours)	3,461	-2,439	5,900
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-1699 - Current		11/18/2021

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

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