Form SSA-1696-U4, Appointment of Representative is a form used for appointing a third-party representative who will act on your behalf when doing business with the Social Security Administration (SSA). The form - also known as the SSA Form 1696-U4 or the SSA Appointment of Representative - was released in March 2018. An SSA-1696-U4 fillable form is available for download and digital filing below.
Dealing with the SSA may be troublesome - especially for the individuals requesting disability benefits - and often requires a lot of paperwork. In this case, the SSA gives you an opportunity to appoint a representative who will deal with the official procedures for you. You may choose any person you want to act as your representative, including your attorney or close relative. It is very important that you appoint a qualified and reliable person because the appointed representative will have right to act for you in most Social Security cases, and the SSA will work with this person just as they would with you.
According to the SSA rules, you are not allowed to choose a company as your representative (e.g. law firm), but you can appoint several individuals working in the company. The appointed representative will be able to:
The SSA will continue working with your representative unless you provide them with a written notification of withdrawal, or the representative notifies them about a cessation of performing their duties. The SSA will not work with an individual who is suspended or disqualified. The SSA will inform you in case your representative is suspended. Your representative may ask for a fee. To charge you a fee, your representative must receive an authorization from the SSA.
The SSA Appointment of Representative Form consists of three parts. The first part is completed by a claimant. Parts 2 and 3 are filled out by the representative. You can use one Form SSA-1696 to appoint one representative. If you choose to appoint multiple representatives, submit a separate form for each of them.
Fill out the Form SSA-1696-U4 as follows:
The representative you appoint should complete Part 2. If the appointed individual is not an attorney, it is required to provide the name, confirm the acceptance of the appointment, and sign the form. If your representative requests a fee, it is necessary to check the appropriate box in Part 3, sign and date the form in this section.
The form is completed in four copies. The first one is filed with the SSA, the second copy is for the claimant, the third is for the appointed representative, and the third is for the Office of Hearing Operations (OHO). The OHO is the Social Security hearing office where administrative law judges hold appeals hearings. You need to fill out this copy of the form, as the representative you appoint can request to appeal SSA decisions at a local OHO, provide the office with evidence to support your claim, and accompany you to the hearing.
Mail or fax your SSA-1696-U4 Form to the local Social Security office. Specify the mailing address and fax number of your Social Security Office on the SSA official website or by calling the toll-free Customer Service number provided at the second page of the form. Moreover, you can find a full list of the offices in your telephone directory under U.S. Government agencies. If you appoint multiple representatives, make sure that each of them has completed Part 2 of the appropriate form.
Oops! This feature is under construction and will be available soon.