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404.1707(a); 416.1507(a) - You [claimant] complete and sign our prescribed appointment form - SSA-1696 (0960-0527)
NPRM for Administrative Rules for Claimant Representation and Provisions for Direct Payment to Entities (Marasco Decision), RIN 0960-AI22
OMB: 0960-0832
IC ID: 261464
OMB.report
SSA
OMB 0960-0832
ICR 202308-0960-002
IC 261464
( )
Documents and Forms
Document Name
Document Type
Form SSA-1696
404.1707(a); 416.1507(a) - You [claimant] complete and sign our prescribed appointment form - SSA-1696 (0960-0527)
Form and Instruction
SSA-1696 Confirmation of Appointment_New notices _Withwithout Assignment Language - Marasco-Related.docx
Other-Notice
SSA-1696 Confirmation of Appointment_New notices _Withwithout Assignment Language - Marasco-Related.docx
Other-Notice
SSA-1696 Claimant's Appointment of a Representative
SSA-1696 - Revised Version.pdf
www.ssa.gov
Form and Instruction
SSA-1696 Claimant's Appointment of a Representative
SSA-1696 - Revised Version.pdf
www.ssa.gov
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
404.1707(a); 416.1507(a) - You [claimant] complete and sign our prescribed appointment form - SSA-1696 (0960-0527)
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 404.1707(a)
20 CFR 416.1507(a)
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
Claimant's Appointment of a Representative
SSA-1696 - Revised Version.pdf
www.ssa.gov
Yes
Yes
Fillable Fileable Signable
Other-Notice
SSA-1696 Confirmation of Appointment_New notices _Withwithout Assignment Language - Marasco-Related.docx
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,100,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
50 %
Requested
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
1,100,000
0
0
0
Annual IC Time Burden (Hours)
128,333
0
128,333
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.