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

Appointment of Representative

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0527 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1696-SUP2 Representative's Withdrawal of Acceptance of an Appointment - SSA-1696-SUP2 Form and Instruction
SSA-1696-SUP2 Representative's Withdrawal of Acceptance of an Appointm SSA-1696-SUP2 - New Form.pdf www.ssa.gov Form and Instruction

Information Collection (IC) Details

IC Title:	Representative's Withdrawal of Acceptance of an Appointment - SSA-1696-SUP2	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1696-SUP2	Representative's Withdrawal of Acceptance of an Appointment	SSA-1696-SUP2 - New Form.pdf	www.ssa.gov	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 233,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	233,000	233,000
Annual IC Time Burden (Hours)	19,417	19,417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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