Information Collection

Written Fee Agreements on Representative's Stationary

IC 256684 under ICR 202409-0960-004 · OMB 0960-0810.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0810 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Sample Written Fee Agreement (Current Version).pdf	Other-Sample Representative-Written
Sample Written Fee Agreement (Current Version).pdf	Other-Sample Representative-Written

IC Title:

Written Fee Agreements on Representative's Stationary

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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
Other-Sample Representative-Written Fee Agreement					No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,067,200

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	Previously Approved
Annual Number of Responses for this IC	1,067,200	1,067,200
Annual IC Time Burden (Hours)	355,733	355,733
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.

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