Appointment of Representative

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-1696-BK Appointment of Representative	Form and Instruction	Modified	Available
Form SSA-1696 Appointment of Representative	Form and Instruction	Modified	Available
Form SSA-1696 Appointment of Representative	Form and Instruction	New	Available
Form SSA-1696 Appointment of Representative	Form and Instruction	New	Available
Form SSA-1696-SUP2 Representative's Withdrawal of Acceptance of an Appointment	Form and Instruction	Modified	Available
Form SSA-1696-SUP1 Claimant's Revocation of the Appointment of a Representative	Form and Instruction	Modified	Available
Addendum - 0527 (Final).docx	Supplementary Document	Uploaded 2026-07-30	Available
Supporting Statement - 0527 (Final).docx	Supporting Statement A	Uploaded 2026-07-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9438	Appointment of Representative - SSA-1696 and e1696	Form and Instruction	Modified	Appointment of Representative
9438	Appointment of Representative - SSA-1696 and e1696	Form and Instruction	Modified	Appointment of Representative
9438	Appointment of Representative - SSA-1696 and e1696	Other-Internet Screens	Modified
281175	Claimants - SSA-1696 and e1696	Form and Instruction	New	Appointment of Representative
281175	Claimants - SSA-1696 and e1696	Form and Instruction	New	Appointment of Representative
281175	Claimants - SSA-1696 and e1696	Other-Internet Screens	New
235152	Representative's Withdrawal of Acceptance of an Appointment - SSA-1696-SUP2	Form and Instruction	Modified	Representative's Withdrawal of Acceptance of an Appointment
235152	Representative's Withdrawal of Acceptance of an Appointment - SSA-1696-SUP2	Other-Revised Privacy Act Statement	Modified
235151	Claimant's Revocation of the Appointment of a Representative - SSA-1696-SUP1	Form and Instruction	Modified	Claimant's Revocation of the Appointment of a Representative
235151	Claimant's Revocation of the Appointment of a Representative - SSA-1696-SUP1	Other-Revised Privacy Act Statement	Modified

ICR Details

OMB Control No: 0960-0527	ICR Reference No: 202606-0960-009
Status: Received in OIRA	Previous ICR Reference No: 202203-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Appointment of Representative
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/31/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2026
Responses	3,978,301	1,360,330
Time Burden (Hours)	552,178	241,694
Cost Burden (Dollars)	0	0

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Abstract: Individuals claiming rights or benefits under the Act must notify SSA in writing using our prescribed appointment form, Form SSA-1696, or the submittable electronic version, e1696, to appoint an individual to represent them in dealing with SSA. In addition, as part of SSA’s regulations, SSA requires both claimants and representatives to sign our prescribed form and file it with SSA before SSA will recognize the appointment. Claimants use Form SSA-1696, or e1696, to appoint a representative to handle their claim before SSA. They may also use the SSA-1696 (or e1696) to name their principal representative. Their selected representative(s) can use the SSA-1696, or e1696, to indicate whether they will charge a fee, to show their eligibility for direct fee payment, and to assign direct payment of their fee to an entity. In addition, representatives also use the SSA-1696, or e1696, to inform SSA of their disbarment; suspension from a court or bar in which they previously admitted to practice; or their disqualification from participating in or appearing before a Federal program or agency. SSA uses the information on the SSA-1696, or e1696, to document the appointment of the representative. We also use this form to collect the representative’s business affiliation and employer identification number. In addition, claimants may use the SSA-1696-SUP1 to revoke their appointment of a representative, and representatives may use the SSA-1696-SUP2 to withdraw their acceptance of the appointment. SSA uses the information on the SSA-1696-SUP1 and SSA-1696-SUP2 to document the revocation and withdrawal of a representative. Respondents are applicants for, or recipients of, Social Security disability benefits (SSDI); SSI payments; or anyone pursuing a benefit or invoking a right under SSA programs, who are notifying SSA they wish to appoint someone to represent them in their dealings with SSA; representatives being appointed by a claimant; as well as individuals revoking the appointment of a representative, and representatives withdrawing from an appointment.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 406 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 30774	05/26/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 48475	07/31/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Appointment of Representative - SSA-1696 and e1696	SSA-1696, SSA-1696-BK	Appointment of Representative ,   Appointment of Representative
Claimant's Revocation of the Appointment of a Representative - SSA-1696-SUP1	SSA-1696-SUP1	Claimant's Revocation of the Appointment of a Representative
Claimants - SSA-1696 and e1696	SSA-1696, SSA-1696	Appointment of Representative ,   Appointment of Representative
Representative's Withdrawal of Acceptance of an Appointment - SSA-1696-SUP2	SSA-1696-SUP2	Representative's Withdrawal of Acceptance of an Appointment

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,978,301	1,360,330	0	0	2,617,971	0
Annual Time Burden (Hours)	552,178	241,694	0	0	310,484	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we cleared this ICR in 2023, the burden was 269,167 hours. However, we are currently reporting a burden of 393,264 hours. This increase in burden is partially due to the requirement for respondents to use the SSA-1696 specifically (as per our previous approval under the regulatory changes for the Administrative Rules for Claimant Representation and Provisions for Direct Payment to Entities (Marasco Decision), which OMB already approved under OMB No. 0960-0832. We are including this minor burden increase here prior to discontinuing the OMB approval for 0960-0832. In addition, we have noted an increase in the usage of both the SSA-1696-SUP1 and SSA-1696-SUP2 over the past three years. Regarding the supplemental forms, while the number of responses increased, SSA did not take any actions which would cause this change, nor have we changed the burden per response for these two forms. These figures represent current Management Information data. *Note: The total burden reflected in ROCIS is 552,178, while the burden cited in #12 of the Supporting Statement is 393,264. This discrepancy is because the ROCIS burden also includes the estimated learning costs for these forms. In contrast, the chart in #12 above reflects actual burden.

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Annual Cost to Federal Government: $8,119,509

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Yes

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/31/2026

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