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

Appointment of Representative

Documents and Forms

Document Name Document Type
Form SSA-1696-SUP2 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 - Current Version.pdf www.ssa.gov Form and Instruction
SSA-1696-SUP2 Representative's Withdrawal of Acceptance of an Appointm SSA-1696-SUP2 - Current Version.pdf www.ssa.gov Form and Instruction

Information Collection (IC) Details

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: Modified

Obligation to Respond: Voluntary

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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1696-SUP2	Representative's Withdrawal of Acceptance of an Appointment	SSA-1696-SUP2 - Current Version.pdf	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: 254,825	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	254,825	21,825	233,000
Annual IC Time Burden (Hours)	21,235	1,818	19,417
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.