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Federal forms, ICRs, and supporting documents

Information Collection

Appointment of Representative - SSA-1696 and SSA-1696-App

IC 9438 under ICR 202203-0960-001 · OMB 0960-0527.

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-SSA-1696-APP - Submittable PDF
Other-SSA-1696-APP - Submittable PDF
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Appointment of Representative - SSA-1696 and SSA-1696-App
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1507 20 CFR 410.684 20 CFR 404.1720 20 CFR 404.1707 20 CFR 414.1725

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-1696 Appointment of Representative SSA-1696 (Revised).pdf www.ssa.gov Yes No Fillable Printable
Other-SSA-1696-APP - Submittable PDF Screens SSA-1696-APP Screens.pdf www.ssa.gov Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

1,100,000 0
   
Individuals or Households
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,100,000 0 0 300,000 0 800,000
Annual IC Time Burden (Hours) 220,000 0 0 60,000 0 160,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-1696 SSA-1696 - Current Version.pdf 05/19/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.