Information Collection

SSA-1699 (0960-0732) - 404.1705(c); 404.1730(e)(v); 404.1735(b); 416.1505(c); 416.1530(e)(v); 416.1535(b)

IC 261460 under ICR 202408-0960-006 · OMB 0960-0832.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1699 SSA-1699 (0960-0732) - 404.1705(c); 404.1730(e)(v); 404.1735(b); 416.1505(c); 416.1530(e)(v); 416.1535(b)	Form and Instruction
Form SSA-1699 SSA-1699 (0960-0732) - 404.1705(c); 404.1730(e)(v); 404.1735(b); 416.1505(c); 416.1530(e)(v); 416.1535(b)	Form and Instruction
SSA-1699 Registration for Appointed Representative Services and D SSA-1699 (Revised Version).pdf www.ssa.gov	Form and Instruction
SSA-1699 Registration for Appointed Representative Services and D SSA-1699 (Revised Version).pdf www.ssa.gov	Form and Instruction
SSA-1699 (Current Version).pdf Current SSA-1699	IC Document
SSA-1699 (Current Version).pdf Current SSA-1699	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1730(e)(v) 20 CFR 404.1705(c) 20 CFR 404.1735(b) 20 CFR 416.7505(c) 20 CFR 416.1530(e)(v) 20 CFR 416.1535(b)

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-1699	Registration for Appointed Representative Services and Direct Payment	SSA-1699 (Revised Version).pdf	www.ssa.gov	Yes	Yes	Fillable Printable

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: 0 %

table that charts list of burden
	Approved	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

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-1699	SSA-1699 (Current Version).pdf	08/12/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.