SSA-1696 (0960-0527) - 404.1730(e)(2); 416.1530(e)(2) - A representative may rescind an assignment before the date on which we notify you of our first favorable determination or decision

Final Rule for Administrative Rules for Claimant Representation and Provisions for Direct Payment to Entities (Marasco Decision), RIN 0960-AI22

Documents and Forms

Document Name Document Type
Form SSA-1696 SSA-1696 (0960-0527) - 404.1730(e)(2); 416.1530(e)(2) - A representative may rescind an assignment before the date on which we notify you of our first favorable determination or decision Form and Instruction
Form SSA-1696 SSA-1696 (0960-0527) - 404.1730(e)(2); 416.1530(e)(2) - A representative may rescind an assignment before the date on which we notify you of our first favorable determination or decision Form and Instruction
SSA-1696 Claimant's Appointment of a Representative SSA-1696 (Revised Version).pdf www.ssa.gov Form and Instruction
SSA-1696 Claimant's Appointment of a Representative SSA-1696 (Revised Version).pdf www.ssa.gov Form and Instruction
SSA-1696-APP Claimant’s Appointment of a Representative SSA-1696-APP Screens (Revised Version).pdf www.ssa.gov Form and Instruction
SSA-1696-APP Claimant’s Appointment of a Representative SSA-1696-APP Screens (Revised Version).pdf www.ssa.gov Form and Instruction
SSA-1696 (Current Version).pdf Current SSA-1696 IC Document
SSA-1696 (Current Version).pdf Current SSA-1696 IC Document
SSA-1696-APP Screens (Current Version).pdf Current SSA-1696-APP Screens IC Document
SSA-1696-APP Screens (Current Version).pdf Current SSA-1696-APP Screens IC Document

Information Collection (IC) Details

IC Title:	SSA-1696 (0960-0527) - 404.1730(e)(2); 416.1530(e)(2) - A representative may rescind an assignment before the date on which we notify you of our first favorable determination or decision	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 404.1730(e)(2) 20 CFR 416.1530(e)(2)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1696	Claimant's Appointment of a Representative	SSA-1696 (Revised Version).pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	SSA-1696-APP	Claimant’s Appointment of a Representative	SSA-1696-APP Screens (Revised Version).pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150,000	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: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150,000	150,000
Annual IC Time Burden (Hours)	7,500	7,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-1696	SSA-1696 (Current Version).pdf	08/12/2024
Current SSA-1696-APP Screens	SSA-1696-APP Screens (Current Version).pdf	08/12/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.