Form SSA-1699 "Registration for Appointed Representative Services and Direct Payment"

What Is Form SSA-1699?

Form SSA-1699, Registration for Appointed Representative Services and Direct Payment, is a document that individuals can use when they would like to register for direct payment of fees. Individuals can also use this form if they have registered as an appointed representative before but now want to change some of the information they have submitted in the past.

Individuals can be required to submit the SSA-1699 Form if they have received a notice from the Social Security Administration (SSA) which instructs them to file for the registration. This form was developed by the SSA and was last revised on September 1, 2013. Form SSA-1699 is available for download below.

The form's purpose is to provide the SSA with information that is required to complete the process of registration. After it is completed, the applied individual will receive an email from the SSA where they will find their Representative ID and a list of the further instructions they should follow.

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Form SSA-1699 Instructions

The SSA-1699 Form consists of several parts, each one of them is dedicated to a different subject. These parts include the following details:

  1. General Information and Instructions. The first section of the form provides the individual with guidelines on how to complete the form. Here, they can learn how to submit it, what will happen if the form will be incomplete, and how to obtain more information about the form if they need it.
  2. Privacy Act Statement. This statement informs the individual how their personal information they designate in the document will be used and kept. Here, individuals can also learn about cases when the information can be disclosed to others.
  3. Personal Identification and Contact Details. Individuals must use this part of the document to designate their personal information, which includes their name, date of birth, and Social Security Number. Additionally, they must indicate their personal contact information which consists of their mailing address, telephone number, fax number, and email address.
  4. Representative Information. Here the individual must indicate the information of the representative. It must contain an address for receipts and notices, telephone number, fax number, and email address they use for business purposes. In addition to this, the individual must designate the preferred method of payment and their tax address.
  5. Perjury Statement. At the end of the form, the individual must declare that the information in the form is true and correct, sign, and date the document.

SSA Form-1699 contains other sections as well, such as a Paper Reduction Act Statement, Bar Information, Organization Details, Attestations, and more.

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Download Form SSA-1699 "Registration for Appointed Representative Services and Direct Payment"

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Registration for
Appointed Representative Services and Direct Payment
Purpose of Form
Complete this form if you:
want to register for direct payment of fees,
registered for direct payment of fees prior to 10/31/2009 and need to update your information,
registered as an appointed representative on or after 10/31/2009 and need to update your information, or
received a notice from the Social Security Administration instructing you to complete this form.
NOTE: If you are not in the business of providing services to Social Security claimants and beneficiaries, but will be
appointed as a representative for a relative, friend, or other acquaintance, YOU DO NOT NEED TO COMPLETE THIS
FORM.
This form also collects information necessary to conform to Internal Revenue Code sections 6041 and 6045(f), which
require us to issue IRS Form 1099-MISC to individuals who represent claimants and receive direct payment of $600 or
more during a tax year.
General Information and Instructions
Complete this form and fax it to the Office of Central Operations at 1-877-268-3827. Do not fax more than one
Form SSA-1699 at a time.
You will receive a notice containing your Representative Identification (Rep ID) once your initial registration is
complete. Allow 2 to 3 weeks to receive your notice.
If you are currently suspended or disqualified from representing claimants in dealings with the Social Security
Administration, you may not register until your suspension has ended or we have reinstated you.
You must update your registration by completing a new form if your personal,
professional,
or business affiliation
information changes including information related to disbarments,
suspensions,
or sanctions.
We may return incomplete or inaccurate forms.
For more information, please call 1-800-772-6270 or visit our website at www.socialsecurity.gov/ar. If you are
hearing impaired, call our TTY number at 1-800-325-0778. You may also visit your local Social Security office.
Explanation of Terms for Completing This Form
Representative – an attorney or individual other than an attorney who meets all of our requirements and is
appointed to represent claimants in dealings with us.
Representative Identification (Rep ID) – a 10-character ID that we assign. You will use this Rep ID in lieu of your
Social Security Number (SSN) if you need to update information on this form.
Form SSA-1699 (09-2013)
Registration for
Appointed Representative Services and Direct Payment
Purpose of Form
Complete this form if you:
want to register for direct payment of fees,
registered for direct payment of fees prior to 10/31/2009 and need to update your information,
registered as an appointed representative on or after 10/31/2009 and need to update your information, or
received a notice from the Social Security Administration instructing you to complete this form.
NOTE: If you are not in the business of providing services to Social Security claimants and beneficiaries, but will be
appointed as a representative for a relative, friend, or other acquaintance, YOU DO NOT NEED TO COMPLETE THIS
FORM.
This form also collects information necessary to conform to Internal Revenue Code sections 6041 and 6045(f), which
require us to issue IRS Form 1099-MISC to individuals who represent claimants and receive direct payment of $600 or
more during a tax year.
General Information and Instructions
Complete this form and fax it to the Office of Central Operations at 1-877-268-3827. Do not fax more than one
Form SSA-1699 at a time.
You will receive a notice containing your Representative Identification (Rep ID) once your initial registration is
complete. Allow 2 to 3 weeks to receive your notice.
If you are currently suspended or disqualified from representing claimants in dealings with the Social Security
Administration, you may not register until your suspension has ended or we have reinstated you.
You must update your registration by completing a new form if your personal,
professional,
or business affiliation
information changes including information related to disbarments,
suspensions,
or sanctions.
We may return incomplete or inaccurate forms.
For more information, please call 1-800-772-6270 or visit our website at www.socialsecurity.gov/ar. If you are
hearing impaired, call our TTY number at 1-800-325-0778. You may also visit your local Social Security office.
Explanation of Terms for Completing This Form
Representative – an attorney or individual other than an attorney who meets all of our requirements and is
appointed to represent claimants in dealings with us.
Representative Identification (Rep ID) – a 10-character ID that we assign. You will use this Rep ID in lieu of your
Social Security Number (SSN) if you need to update information on this form.
Form SSA-1699 (09-2013)
Privacy Act Statement
Collection and Use of Personal Information
Sections 206(a) and 1631(d) of the Social Security Act, as amended, authorize us to collect this information. The
information. We will use the information you provide to facilitate direct payment of authorized fees and to meet the
reporting requirements of the law.
The information you furnish on this form is voluntary. However, failure to provide the requested information will prevent
you from serving as an appointed representative.
We generally use the information you supply for the purpose of facilitating payments. However, we may use it for the
administration and integrity of Social Security programs. We may also disclose information to another person or to
another agency in accordance with approved routine uses, which include but are not limited to the following:
1. To enable a third party or an agency to assist Social Security in establishing rights to Social Security benefits and/
or coverage;
2. To comply with Federal laws requiring the release of information from Social Security records (e.g., to the
Government Accountability Office and Department of Veterans' Affairs);
3. To make determinations for eligibility in similar health and income maintenance programs at the Federal, State,
and local level; and
4. To facilitate statistical research, audit or investigative activities necessary to ensure the integrity of Social Security
programs.
We may also use the information you provide in computer matching programs. Matching programs compare our records
with records kept by other Federal, State, or local government agencies. Information from these matching programs can
be used to establish or verify a person's eligibility for Federally-funded or administered benefit programs and for
repayment of payments or delinquent debts under these programs.
Additional information regarding this form, routine uses of information, and our programs and systems, is available on-line
at
www.socialsecurity.gov
or at your local Social Security office.
Paperwork Reduction Act Statement
This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork
Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and
Budget control number. We estimate that it will take 20 minutes to read the instructions, gather the facts, and answer the
questions. You may send comments on our time estimate, not the completed form, to SSA, 6401 Security Boulevard,
Baltimore, MD, 21235-6401
Form SSA-1699 (09-2013)
Form Approved
Social Security Administration
OMB No. 0960-0732
REGISTRATION FOR APPOINTED REPRESENTATIVE SERVICES AND DIRECT PAYMENT
Complete all sections that apply to you. We will return incomplete or inaccurate forms.
Section I: Your Personal Identification and Home Contact Information
All fields in this section are required unless indicated as optional. For your protection, we collect your home contact
information to check against our records.
If you need to update information you provided on or after 10/31/09, include your name, Rep ID, and all information that has
changed. You must attest, sign, and date the updated form.
Enter your name in the boxes below exactly as it appears on your Social Security card. If you want to use a different name,
contact your local Social Security office to change the name currently in our records. You must either receive a new card or
receive confirmation that we processed your name change prior to completing this form.
If you registered as an Appointed Representative on or after 10/31/09 and need to update your information,
enter your Rep ID below:
Your First Name
Your Middle Name
Your Last Name
Your Suffix (if any)
Your Date of Birth (MM/DD/YYYY)
Your Social Security Number
Your Home Mailing Address
Line 1
Street
Line 2
City
State
ZIP/Postal Code
Country (if outside the U.S.)
Your Daytime Telephone Number
Your Home Fax Number (Optional)
Country/Area Code
Phone Number
Extension
Country/Area Code
Fax Number
Your Email Address (Optional - Used for registration purposes and Social Security online service messages.)
Form SSA-1699 (09-2013)
1
Destroy Prior Editions
Section II: Your Representational Standing
Check one of the boxes below.
Are you currently in good standing and admitted to practice law before the U.S. Supreme Court; a U.S. Federal, state, territorial,
insular possession, or District of Columbia court; or a member of a state bar if that membership carries with it the authority to
practice law in that state?
Yes
(Go to Section III)
No (Go to Section IV)
NOTE: If you are not in the business of providing services to Social Security claimants and beneficiaries, but will be appointed as
a representative for a relative, friend, or other acquaintance, YOU DO NOT NEED TO COMPLETE THIS FORM.
Section III: Your Bar and Court Information
Provide information for one state, U.S. territory, or U.S. Federal Court in which you currently are in good standing and have the
right to practice law.
Year
Court or Bar License Number
Court or Bar
Admitted
(If one issued)
(YYYY)
Form SSA-1699 (09-2013)
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Section IV: Your Information as a Representative
All representatives must complete this section.
1. Your Address for Receipt of Notices
Same as Home Address in Section I
Street
Line 1
Line 2
City
State
ZIP/Postal Code
Country(if outside the U.S.)
Business Telephone Number (if different from that
Business Fax Number (Optional)
2.
provided in Section I.)
Country/Area Code
Phone Number
Extension
Country/Area Code
Fax Number
3. Business Email Address (Optional)
4.
Yes
Did you check “Yes” in Section II OR have you been notified by us
that you are eligible for direct payment of your fees?
No
(Go to Section VI)
5.
What is your preferred payment method?
Direct Deposit to U.S. Bank – I am the owner or co-owner of this account. (You must be the
owner or co-owner)
Checking
Savings
Type of Financial Account:
Routing Number
Account Number
OR
Check – Will be mailed to the Notice Address
6.
Same as Home Address
Your Tax Address (This is the address where
we will send your FORM 1099-MISC)
Same as Notice Address in 1 in this section
Street
Line 1
Line 2
City
State
ZIP/Postal Code
Country(if outside the U.S.)
Form SSA-1699 (09-2013)
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