Information Collection

404.1707(a); 416.1507(a) - You [claimant] complete and sign our prescribed appointment form - SSA-1696 (0960-0527)

IC 261464 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

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-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

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 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,100,000	1,100,000
Annual IC Time Burden (Hours)	128,333	128,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.