Information Collection

Representative's Withdrawal of Acceptance of an Appointment - SSA-1696-SUP2

IC 235152 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-SUP2 Representative's Withdrawal of Acceptance of an Appointment Representative's Withdrawal of Acceptance of an Appointment - SSA-1696-SUP2	Form and Instruction
SSA-1696-SUP2 - Revised PA Statement.docx www.ssa.gov	Other-Revised Privacy Act Statement
SSA-1696-SUP2 Representative's Withdrawal of Acceptance of an Appointm SSA-1696-SUP2 - Revised Version (marked-up).pdf www.ssa.gov (Upload Documents)	Form and Instruction
SSA-1696-SUP2 - Current Version.pdf Current SSA-1696-SUP2	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 416.1507 20 CFR 404.1720 20 CFR 416.1520 20 CFR 404.1707 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-SUP2			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: 252,000

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	252,000	-2,825	254,825
Annual IC Time Burden (Hours)	25,200	3,965	21,235
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-1696-SUP2		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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