Information Collection

Claimant's Revocation of the Appointment of a Representative - SSA-1696-SUP1

IC 235151 under ICR 202606-0960-009 · OMB 0960-0527.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1696-SUP1 Claimant's Revocation of the Appointment of a Representative Claimant's Revocation of the Appointment of a Representative - SSA-1696-SUP1	Form and Instruction
SSA-1696-SUP1 - Revised PA Statement.docx www.ssa.gov	Other-Revised Privacy Act Statement
SSA-1696-SUP1 Claimant's Revocation of the Appointment of a Representa SSA-1696-SUP1 - Revised Version (mock-up).pdf www.ssa.gov (Upload Documents)	Form and Instruction
SSA-1696-SUP1 - Current Version.pdf Current SSA-1696-SUP1	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.1520 20 CFR 416.1507 20 CFR 404.1707 20 CFR 404.1720 20 CFR 408.1101

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-1696-SUP1			www.ssa.gov (Upload Documents)	Yes	Yes	Fillable Printable
Other-Revised Privacy Act Statement				www.ssa.gov	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 21,959

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	21,959	16,454	5,505
Annual IC Time Burden (Hours)	2,196	1,737	459
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-1696-SUP1		07/30/2026

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

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