The agency will
ensure that the revised version of the SSA-1696 will have fully
fill-able fields for all fields related to SSNs and Rep ID numbers.
Prior to rebusmission of this ICR Prior to resubmission of this
ICR, the agency will ensure the the signature field is fully
fillable as well
Inventory as of this Action
Requested
Previously Approved
06/30/2022
06/30/2022
06/30/2022
1,054,000
0
1,054,000
181,167
0
181,167
0
0
0
Recipients use Form SSA-1696 to
appoint a representative to handle their claim before SSA.
Recipients’ representatives use the Form SSA-1696 to indicate
whether they will charge a fee, and, if so, specify their
eligibility for direct fee payment. The representatives also use
Form SSA 1696 to indicate their disbarment or 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 recognizes the recipient’s
representative as the individual named in a notice of appointment
(or written statement), which the recipient signed and filed at an
SSA office. The SSA 1696 (or written statement) documents the
appointment of a representative. We also use this form to collect
the business affiliation and EIN of the representatives. Our
regulations also require that if the representative is a non
attorney, they must sign the form or equivalent written statement.
In addition, respondents use the SSA 1696-SUP1 to revoke their
appointment of a representative, and representatives use the SSA
1696-SUP2 to withdraw their acceptance of the appointment. SSA uses
this information 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 have appointed a person to represent them in
their dealings with SSA, and their non attorney representatives who
need to sign the form. This is a non-substantive Change Request to
make minor revisions to the form to remove redundancies, and
clarify language.
US Code:
42
USC 406 Name of Law: Social Security Act
US Code: 42
USC 1383 Name of Law: Social Security Act
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:
(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;
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.