Form SSA-1699

Registration of Individuals and Staff for Appointed Representative Services

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0732 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1699 Form SSA-1699 Form and Instruction
SSA-1699 Registration for Appointed Representative Services and D SSA-1699.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Form SSA-1699	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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 for Appointed Representative Services and Direct Payment	SSA-1699.pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	16,000	-36,800	52,800
Annual IC Time Burden (Hours)	5,333	-12,267	17,600
Annual IC Cost Burden (Dollars)	0	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.