Addendum to Supporting Statement for 0960-0730

Addendum to the Supporting Statement for Form SSA-1695

Identifying Information for Possible Direct Payment of Authorized Fees

OMB No. 0960-0730

Terms of Clearance

This form is approved for two years only. In years past, SSA planned to introduce a new system, which would enable information to be filled out online and would not require respondents to provide their social security number. This form was intended to be discontinued at that point. Due to lack of program support and budget constraints, there is not a current project planned which would lead to discontinuation of the SSA-1695.

In July of 2009, OMB placed the above Terms of Clearance on this information collection. At the time, SSA believed our new Appointed Representative system would be in place and usable within a year from the approval date for this collection. Given that our new system would have allowed us to obsolete this collection, we informed OMB of our intent to discontinue the paper SSA-1695 upon implementation of the new Appointed Representative Suite of Services.

In January 2010, SSA put Phases II and III or the Appointed Representative Suite of Services project on hold due to issues with Phase I, individual registration, and access to the electronic folder. Social Security decided to discontinue the new Internet application for the SSA-1699 and conduct additional usability testing. As a result, we developed a simplified paper version of the SSA-1699 to use during the interim. In our original plan, we intended to implement a new SSA-1696 that would capture the same information currently obtained via the SSA-1695, thereby rendering the current SSA-1695 obsolete. We also wanted to expand the new SSA-1696 to collect more information between the claimant and the attorney. Since the implementation of Phase III of the Appointed Representative Suite of Services project did not go as planned, we could not discontinue the SSA-1695 in July 2010.

With the delay of Phases II and III of the Appointed Representative Suite of Services project, it is crucial that we receive OMB approval for the SSA-1695. Currently, there is no timeline set by SSA to implement additional phases of the Appointed Representative Suite of Services project. Until we can conduct discussions with the representatives and revise our Appointed Representative Suite of Services plans, it is very difficult to estimate when we can discontinue Form SSA-1695. It is critical for SSA to keep the current form active; therefore, we are seeking a 3-year extension from OMB for Form SSA-1695.

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

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 Statement on the first page of the form.