Information Collection

Non-Attorney Representative Demonstration Project - Paper Application

IC 191052 under ICR 202504-0960-003 · OMB 0960-0699.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1691 Non-Attorney Representative Demonstration Project - Paper Application	Form and Instruction
Form SSA-1691 Eligible Non-Attorney Representative Non-Attorney Representative Demonstration Project - Paper Application	Form and Instruction
SSA-1691 Eligible Non-Attorney Representative SSA-1691 (revised).pdf	Form and Instruction
SSA-1691 Eligible Non-Attorney Representative SSA-1691 (revised).pdf	Form and Instruction
SSA-1691 (current).pdf SSA-1691 - Current	IC Document
SSA-1691 (current).pdf SSA-1691 - Current	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 404.1745 - 404.1799 20 CFR 416.1545 - 416.1599

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-1691				No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 156

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	156	156
Annual IC Time Burden (Hours)	117	117
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-1691 - Current		04/17/2025

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

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