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⚠️ Notice: This information collection may be referencing outdated material.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

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

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 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

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.