Registration for Appointed Representative Services and Direct Payment

Forms and Documents

Document Name	Status
Form SSA-1699 Form SSA-1699 Form and Instruction	Modified
Supporting Statement - 0732.docx Supporting Statement A	2019-07-23
Addendum - 0732.docx Supplementary Document	2019-07-23

IC Document Collections

IC ID	Document Title	Status
43720	Form SSA-1699 Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0732	ICR Reference No: 201903-0960-007
Status: Active	Previous ICR Reference No: 201601-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Registration for Appointed Representative Services and Direct Payment
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: 10/31/2019
	Date Received in OIRA: 07/29/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2022	36 Months From Approved	10/31/2019
Responses	17,700	0	16,000
Time Burden (Hours)	5,900	0	5,333
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses Form SSA-1699 to register appointed representatives of claimants before SSA who: • Want to register for direct payment of fees; • Registered for direct payment of fees prior to 10/31/09, but need to update their information; • Registered as appointed representatives on or after 10/31/09, but need to update their information; or • Received a notice from SSA instructing them to complete this form. By registering these individuals, SSA: (1) authenticates and authorizes them to do business with us; (2) allows them to access our records for the claimants they represent; (3) facilitates direct payment of authorized fees to appointed representatives; and, (4) collects the information we need to meet Internal Revenue Service (IRS) requirements to issue specific IRS forms if we pay an appointed representative in excess of a specific amount ($600). The respondents are appointed representatives who want to use Form SSA-1699 for any of the purposes cited above.

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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:
	84 FR 18913	05/02/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 34469	07/18/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Form SSA-1699	SSA-1699	Registration for Appointed Representative Services and Direct Payment

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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	17,700	16,000	0	0	1,700	0
Annual Time Burden (Hours)	5,900	5,333	0	0	567	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2016, the burden was 5,333. However, we are currently reporting a burden of 5,900 hours. This change stems from an increase in the number of responses from 16,000 to 17,700. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change.

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Annual Cost to Federal Government: $192,000

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 07/29/2019

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