Form SSA-1696 | Appointment of Representative | SSA You can sign and submit a written statement appointing the person, or use our standard form SSA-1696, Appointment of Representative You can use our electronic version of the form by asking your representative to start an online submission where you both can complete your appointment electronically without personal contact
ssa-1696 We will use the information you provide on this form to verify your appointment of an individual as your representative and his or her acceptance of the appointment
SSA 1696 Appointment of Representative - omb. report You may use this electronic version of Form SSA-1696 to appoint a representative However, we do not require you to use this electronic version; you can still use the paper version to tell us about your appointment
rComplete Form SSA-1696 Claimants Appointment of a Representative To designate an affiliate entity for this claim, you must have already submitted to us a Form SSA-1699 that identifies this entity as an affiliate \(If you do not want to designate an affiliate \ entity for this claim, or do not qualify for or seek direct payment, mark no EIN \)
Claimants Appointment of a Representative - Allsup I accept appointment as the representative for the claimant named in Section 2 of this form in connection with the claims and asserted rights described in Section 6 of this form I agree that a copy of this signed form SSA-1696 will have the same force and effect as the original
Completing This Form to Appoint a Representative How to Complete this Form Please print or type your answers on this form At the top of the form, provide your full name and your Social Security number If your claim is based on another person's work and earnings, also provide the “wage earner's” name and Social Security number
COMPLETING THIS FORM TO APPOINT A REPRESENTATIVE Furnishing us this information is voluntary However, if you want to use this form to appoint someone to act on your behalf in matters before the Social Security Administration (SSA), then you and that individual must complete the appropriate sections of this form