Information Collection

404.1705(c); 416.1505(c) - Your representative(s) must be registered with us in the manner we prescribe before you submit the appointment(s) - SSA-1699 (0960-0732)

IC 261460 under ICR 202308-0960-002 · OMB 0960-0832.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0832 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1699 404.1705(c); 416.1505(c) - Your representative(s) must be registered with us in the manner we prescribe before you submit the appointment(s) - SSA-1699 (0960-0732) Form and Instruction
SSA-1699 Registration for Appointed Representative Services and D SSA-1699 (revised).pdf www.ssa.gov Form and Instruction
SSA-1699 Registration for Appointed Representative Services and D SSA-1699 (revised).pdf www.ssa.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	404.1705(c); 416.1505(c) - Your representative(s) must be registered with us in the manner we prescribe before you submit the appointment(s) - SSA-1699 (0960-0732)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.1505(c) 20 CFR 404.1705(c)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1699	Registration for Appointed Representative Services and Direct Payment	SSA-1699 (revised).pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,382	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: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15,382	15,382
Annual IC Time Burden (Hours)	5,127	5,127
Annual IC Cost Burden (Dollars)	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.