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Representative's Withdrawal of Acceptance of an Appointment - SSA-1696-SUP2
 
No Modified
 
Voluntary
 
20 CFR 416.1507 20 CFR 404.1720 20 CFR 416.1520 20 CFR 404.1707 20 CFR 408.1101

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-1696-SUP2 www.ssa.gov (Upload Documents) Yes Yes Fillable Printable
Other-Revised Privacy Act Statement www.ssa.gov Yes No Printable Only

Income Security General Retirement and Disability

 

252,000 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 252,000 0 0 -2,825 0 254,825
Annual IC Time Burden (Hours) 25,200 0 0 3,965 0 21,235
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-1696-SUP2 07/30/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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