Supporting Statement for Form SSA-1695
Identifying Information for Possible Direct Payment of Authorized Fees
OMB No. 0960-0730
Justification
Introduction/Authoring Laws and Regulations
Pursuant to sections 206(a) and 1631(d) of the Social Security Act, the Social Security Administration (SSA) collects the information on this form to facilitate direct payment of authorized fees to an attorney or other person who represents claimants for benefits before SSA. SSA also uses the information to meet any requirement to issue a Form 1099-MISC, pursuant to 26 USC 6041 and 26 USC 6045(f) of the United States Code, under the Internal Revenue Service.
Description of Collection
SSA collects information on from claimants’ appointed representatives on Form SSA–1695 to: (1) Process and facilitate direct payment of authorized fees; (2) issue a Form 1099–MISC, if applicable; and (3) establish a link between each claim for benefits and the data we collect on the SSA–1699 for our appointed
representative database. The respondents are attorneys and other individuals who represent claimants for benefits before SSA.
Use of Information Technology to Collect the Information
Form SSA-1695 is available as a downloadable PDF, which the representatives can print, complete, and send to SSA.
SSA did not create an electronic version of Form SSA-1695 under the agency’s Government Paperwork Elimination Act (GPEA) plan because Form SSA-1695 does not become part of the claims file; after we enter it into the appropriate systems, SSA destroys the form.
Why We Cannot Use Duplicate Information
The nature of the information we are collecting and the manner in which we are collecting it preclude duplication. SSA does not use another collection instrument to collect similar data.
Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities.
Consequence of Not Collecting Information or Collecting it Less Frequently
SSA does not currently have another process for collecting the information. The information provided by appointed representatives facilitates direct payment of authorized fees in each claim, and meets the requirements to issue a Form 1099-MISC. Therefore, if we did not use Form SSA-1695, we would be unable to meet the requirements to issue a Form 1099-MISC, or to pay authorized fees directly. Since SSA collects this information on an as-needed basis, we cannot collect it less frequently.
There are no technical or legal obstacles to burden reduction.
Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on February 10, 2015, at 80 FR 7521, and we received no public comments. The 30-day FRN published on April 9, 2015 at 80 FR 19102. If we receive any comments in response to this Notice, we will forward them to OMB.
Payment or Gifts to Respondents
SSA provides no payment or gifts to respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information we collect in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Modality of Completion |
Number of Respondents |
Frequency of Response |
Average Burden per Response (minutes) |
Estimated Total Annual Burden (hours) |
SSA-1695 |
10,000 |
40 |
10 |
66,667 |
The total burden for this ICR is 66,667 hours. This figure represents burden hour, and we did not calculate a separate cost burden.
Annual Cost Burden to the Respondents (Other)
This collection does not impose a known cost burden to the respondents.
Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $97,000. This estimate is a projection of the costs for printing and distributing the collection
instrument, and for collecting and processing the form information.
Program Changes or Adjustments to the Information Collection Request
There are no changes in the public reporting burden.
Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
Displaying the OMB Approval Expiration Date
OMB exempted SSA from publishing the expiration date for OMB approval on its forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that of an OMB approval. SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis). OMB granted this exemption so SSA would not have to discontinue using otherwise usable editions of forms with outdated expiration dates. In addition, SSA avoids Government waste, because we will not have to destroy and reprint stocks of forms.
Exception to Certification Statement
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
Collections of Information Employing Statistical Methods
SSA is not using statistical methods for this information collection
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | 889123 |
| File Modified | 0000-00-00 |
| File Created | 2021-01-25 |