Form SSA-1696

Form SSA-1696 is used by the Social Security Administration (SSA) to document your appointment of a representative in your dealings with the SSA. The form will contain your representative’s name, address, and phone number, as well as yours, and is valid only when signed by you or your parent or legal guardian. Non-attorney representatives also must sign the form to accept the appointment. Law firms, corporations, or other organizations cannot be appointed as representative; the form must be signed by an individual. If an individual signs on behalf of a corporation or firm, the individual signing the document is considered the representative.

The SSA must have Form SSA-1696 in your file in order to allow it to communicate with your representative or your representative’s staff regarding any aspect of your case. Once the form has been processed, your representative will receive copies of most notices that the SSA sends to you, including evidence requests, decision notices, and other correspondence from the SSA. In addition to formally establishing the claimant-representative relationship, Form SSA-1696 indicates whether your representative is charging a fee for services. Various options appear in Section III of the form to indicate whether fees are being requested or waived. If your representative is pursuing a fee for services, then he or she usually will have you sign a Fee Agreement to spell out the details of the fee arrangement.

Form SSA-1696 can be found here on the SSA website.

The Fee Agreement used by Disability Specialists can be found here.