Non-Attorney Representative Demonstration Project - Paper Application

Social Security Administration Eligible Non-Attorney Representative

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0699 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1691 Non-Attorney Representative Demonstration Project - Paper Application Form and Instruction
SSA-1691 Eligible Non-Attorney Representative SSA-1691.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Non-Attorney Representative Demonstration Project - Paper Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1745 - 404.1799 20 CFR 416.1545 - 416.1599

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1691	Eligible Non-Attorney Representative	SSA-1691.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	200,000	200,000

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.