Registration of Individuals and Staff for Appointed Representative Services

Forms and Documents

Document Name	Status
Form SSA-1699 Form SSA-1699 Form and Instruction	Modified
0960-0732 supporting statement (2009).doc Supporting Statement A	2009-07-16
0960-0732 addendum (2009)1 (2).doc Supplementary Document	2009-07-16

IC Document Collections

IC ID	Document Title	Status
43720	Form SSA-1699 Form and Instruction	Modified
189771	Internet SSA-1699 Other-screen shots for online application	New

ICR Details

OMB Control No: 0960-0732	ICR Reference No: 200906-0960-006
Status: Historical Active	Previous ICR Reference No: 200607-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Registration of Individuals and Staff for Appointed Representative Services
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/16/2009
	Date Received in OIRA: 07/16/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2012	36 Months From Approved	10/31/2009
Responses	66,000	0	10,000
Time Burden (Hours)	31,240	0	3,333
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses form SSA-1699 to register the following people: • Individuals appointed as representatives; • Individuals who will perform advocacy services on behalf of an appointed entity representative; • Individuals who will act on behalf of an appointed representative and want access to our electronic services; • Individuals who will serve as administrators for an entity appointed as a representative. By registering these individuals, SSA 1) authenticates and authorizes them to do business with us, 2) allows them access to our records for the claimants they represent, 3) facilitates direct payment of authorized fees to appointed representatives, and 4) collects the information we will need to meet Internal Revenue Service requirements to issue specific IRS forms if we pay these representatives in excess of a specific amount ($600). This information collections request is for changes we will be implementing to the collection later in the year and in early 2010. The respondents are appointed claimant representatives.

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Authorizing Statute(s): US Code: 42 USC 406 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 18782	04/24/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 34616	07/16/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Internet SSA-1699
Form SSA-1699	SSA-1699	Registration of Individual for Appointed Representative Services

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	66,000	10,000	0	56,000	0	0
Annual Time Burden (Hours)	31,240	3,333	0	27,907	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: We added new questions to this form, increasing the response time and the overall burden.

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Annual Cost to Federal Government: $350,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/16/2009

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