Written Fee Agreements on Representative's Stationary

Fee Agreement for Representation before the Social Security Administration

Documents and Forms

Document Name Document Type
Sample Written Fee Agreement (Current Version).pdf Other-Sample Representative-Written

Information Collection (IC) Details

IC Title:	Written Fee Agreements on Representative's Stationary	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
Other-Sample Representative-Written Fee Agreement			Sample Written Fee Agreement (Current Version).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: 1,067,200	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,067,200	1,067,200
Annual IC Time Burden (Hours)	355,733	355,733
Annual IC Cost Burden (Dollars)	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.