Fee Agreement for Representation before the Social Security Administration

Forms and Documents

Document Name	Status
Form SSA-1693 Fee Agreement for Representation before the Social Security Administration Form and Instruction	Modified
Addendum - 0810.docx Supplementary Document	2021-12-14
Supporting Statement - 0810.docx Supporting Statement A	2021-12-14

IC Document Collections

IC ID	Document Title	Status
232717	Fee Agreement for Representation before the Social Security Administration Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0810	ICR Reference No: 202111-0960-003
Status: Received in OIRA	Previous ICR Reference No: 202109-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Fee Agreement for Representation before the Social Security Administration
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/14/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2021
Responses	5,000	600,000
Time Burden (Hours)	1,083	120,000
Cost Burden (Dollars)	0	0

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Abstract: The Social Security Act requires individuals who represent a claimant before the agency and want to receive a fee for their services to obtain SSA’s authorization of the fee. One way to obtain the authorization is to submit the fee agreement to the agency either in writing or through using Form SSA-1693, Fee Agreement for Representation before the Social Security Administration. Since representatives currently use fee agreements which vary in length, content, and complexity, submission of a free-form fee agreement may cause delays in SSA’s review time. Therefore, SSA encourages respondents to use Form SSA-1693 to submit the information either using the paper form or the electronically submittable e1693 through SSA’s website. SSA uses the information from the SSA-1693 to review the request and authorize any fee to representatives who seek to charge and collect a fee from a claimant. The respondents are the representatives who help claimants through the application process, and the claimants who they represent.

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Authorizing Statute(s): None

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:
	86 FR 47190	08/23/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 64585	11/18/2021
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
Fee Agreement for Representation before the Social Security Administration	e1693, SSA-1693	Fee Agreement for Representation before the Social Security Administration ,   Fee Agreement for Representation before the Social Security Administration

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ICR Summary of Burden

	Total Request	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	5,000	600,000	0	0	-595,000	0
Annual Time Burden (Hours)	1,083	120,000	0	0	-118,917	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: We increased the burden by one minute for this information collection, as the e1693 version required a slight increase in the burden per response of one minute. We based this revised burden on additional feedback from the respondents. However, the overall burden hours have decreased substantially because we are receiving fewer responses than originally expected. See #12 above for burden figures. We based our new figures on current usage data collected over the three years the form has been in circulation. We initially expected a much higher usage for this form, as our current management information data is showing a lower usage, we have updated the figures to show actual usage over the past three years. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data.

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Annual Cost to Federal Government: $226,967

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: 12/14/2021

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