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Form SSA-1699
Registration of Individuals and Staff for Appointed Representative Services
OMB: 0960-0732
IC ID: 43720
OMB.report
SSA
OMB 0960-0732
ICR 200906-0960-006
IC 43720
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0732 can be found here:
2021-11-18 - Revision of a currently approved collection
2019-07-29 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form SSA-1699
Form SSA-1699
Form and Instruction
SSA-1699 Registration of Individual for Appointed Representative
Form SSA-1699 (Revised).pdf
Form and Instruction
Current Form SSA-1699.pdf
Current SSA-1699
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Form SSA-1699
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
SSA-1699
Registration of Individual for Appointed Representative Services
Form SSA-1699 (Revised).pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
52,800
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
52,800
0
42,800
0
0
10,000
Annual IC Time Burden (Hours)
26,400
0
23,067
0
0
3,333
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Current SSA-1699
Current Form SSA-1699.pdf
06/30/2009
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.