Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration

Forms and Documents

Document Name	Status
Form SSA-1560-U4 (revis Petition to Obtain Approval of a Fee for Representing a Claimant Before the Social Security Administration Form	Modified
Form SSA-1560-U4 (revis Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration Form	Modified
Supporting Statement - 0104 (Final).docx Supporting Statement A	2024-03-28
Supporting Statement - 0104.docx Supporting Statement A	2020-04-07
Addendum - 0104.docx Supplementary Document	2020-04-07
Addendum - 0104.docx Supplementary Document	2020-04-07

IC Document Collections

IC ID	Document Title	Status
9068	Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration Form	Modified	Petition to Obtain Approval of a Fee for Representing a Claimant Before the Social Security Administration
9068	Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration Form	Modified

ICR Details

OMB Control No: 0960-0104	ICR Reference No: 202001-0960-005
Status: Active	Previous ICR Reference No: 201612-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/29/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/07/2020
Terms of Clearance: Agency provided additional description and estimations in the supporting statement. The agency also made the form electronically signable by the claimant consistent with the agency's commitments under Sec. 4 (k)(iii) and (iv) of E.O. 14058.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2027	36 Months From Approved	04/30/2024
Responses	24,153	0	44,365
Time Burden (Hours)	12,077	0	22,183
Cost Burden (Dollars)	6,038	0	0

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Abstract: A Social Security claimant's representative, whether an attorney or a non-attorney, uses Form SSA 1560-U4 to petition SSA for authorization to charge and collect a fee. A claimant may also use the form to agree or disagree with the requested fee amount or other information the representative provides on the form. The SSA official responsible for setting the fee uses the information from the form to determine a reasonable fee amount representatives may charge for their services. Respondents are attorneys and non-attorneys who represent claimants for Social Security benefits.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: Social Security Act
   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:
	85 FR 6671	02/05/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 19565	04/07/2020
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
Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration	SSA-1560-U4 (revised)	Petition to Obtain Approval of a Fee for Representing a Claimant Before the Social Security Administration

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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	24,153	44,365	0	0	-20,212	0
Annual Time Burden (Hours)	12,077	22,183	0	0	-10,106	0
Annual Cost Burden (Dollars)	6,038	0	0	0	6,038	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: Previously we reported a burden of 22,183 hours; however, we are currently reporting a burden of 12,077 hours. This burden decrease reflects our most recent management information data, which shows a decrease in the usage for this form. Per our data, this decrease stems from fewer claims processed in FY 2019, which, in turn, means that fewer respondents use this form. We expect this data to fluctuate from year to year, and happen to have seen a steady decrease in the use of this form over the past three years. Although the number of respondents decreased, SSA did not take any actions to cause this change. In addition, we inadvertently did not include the cost burden on the public for printing this form when we last submitted it. We are including that data now.

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Annual Cost to Federal Government: $43,999

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? No

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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: 04/07/2020

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