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Federal forms, ICRs, and supporting documents

Information Collection

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

IC 261464 under ICR 202408-0960-006 · OMB 0960-0832.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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SSA-1696 (0960-0527) - 404.1707(a); 416.1507(a) - You [claimant] complete and sign our prescribed appointment form
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1507(a) 20 CFR 404.1707(a)

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 Printable
Form and Instruction SSA-1696-APP Claimant’s Appointment of a Representative SSA-1696-APP Screens (Revised Version).pdf www.ssa.gov Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

1,100,000 0
   
Individuals or Households
 
   50 %

  Approved 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

Title Document Date Uploaded
Current SSA-1696 SSA-1696 (Current Version).pdf 08/12/2024
Current SSA-1696-APP Screens SSA-1696-APP Screens (Current Version).pdf 08/12/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.