Addendum to Supporting Statement 0960-0810

Addendum to the Supporting Statement for Form SSA-1693

Fee Agreement for Representation before the Social Security Administration

OMB No. 0960-0810

Revision to the Information Collection

We are making the following minor revisions to the collection instrument for the

SSA-1693:

• Change #1: We are revising the language on the first sentence of the “Signatures” paragraph on page 2 of the instructions.

• Old Language: You and your representative must sign and date this form. If you appoint multiple representatives, all representatives who provide representational services on your claim and who do not waive a fee for those

services must sign on a single fee agreement for the fee agreement to be approved. They may use the last page for this purpose.

• New Language: You and your representative must sign and date this form according to our signature policies. If you appoint multiple representatives, all representatives who provide representational services on your claim and who do not waive a fee for those services must sign on a single fee agreement for the fee agreement to be approved. They may use the last page for this purpose.

Justification #1: We are making the revisions to advise users to changes made to SSA’s signature policies.

• Change #2: We are revising the Privacy Act Statements on this collection.

Justification #2: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statements on this collection.