Form SSA-1694 Entity Registration and Taxpayer Information

Form SSA-1694 (XX-XXXX)
Discontinue Prior Editions - Social Security Administration

OMB No. 0960-0731

Instructions for Completing Form SSA-1694
Keep a copy of this form for your records
In this form, “you” and “your” means the entity and/or the individual serving as the “Point of Contact” or POC. “We”,
“us”, “agency” and “SSA” means the Social Security Administration.
We are required to file an informational return (i.e., Form IRS 1099-MISC or 1099-NEC) with the Internal Revenue
Service (IRS) when we make payments of $600 or more to an appointed representative or to a business entity in a
calendar year. To meet this requirement, we must obtain certain information about the entity (e.g., name, address,
and tax information) that we will use to issue Form IRS 1099. We will also use this form to collect other information
necessary for possible direct payment of fees authorized to the appointed representative directly to an entity.
Section 1. Point of Contact (POC) Contact Information
The POC is a registered representative who is designated and authorized by the entity to act and speak on behalf of
the entity. Enter the name of the designated individual who will be responsible, on behalf of the entity, for resolving fee
issues that cannot be resolved with the appointed representative. This individual must be registered as a representative
with us; must agree to take responsibility for ensuring that the entity does not retain any fee in contradiction of the Social
Security Act, agency regulations, or applicable subregulatory guidance; must not be s anctioned from representing
claimants before SSA; and must be the individual who signs this form accepting these responsibilities . The entity, through
a POC, is responsible for keeping this information up to date.
POC Representative ID (Rep ID)
Provide the Rep ID of the registered POC.
Section 2. Employer Identification Number (EIN)
Enter the entity’s EIN. This information is necessary for tax reporting purposes. If the entity does not have an EIN,
please apply for one immediately by filing an SS-4, Application for Employer Identification Number, with the IRS. You
can apply for an EIN online by accessing the IRS website at https://www.irs.gov/businesses.
Name of Business Entity
Enter the entity’s name as shown on Federal tax documents. This should match the name used when filing Form SS-4
to apply for an EIN.
Tax Mailing Address
Enter the entity’s tax mailing address. We will mail Form IRS-1099-MISC or 1099-NEC to this address if we make
payments of $600 or more to the entity in a calendar year.
Section 3. Banking Information for Direct Deposit
Enter the entity’s banking information, including the routing and account number.
Section 4. POC Certification and Signature
You must certify that you are not currently sanctioned from practicing before SSA and assume responsibility to resolve
fee issues that cannot be resolved with the appointed representative.
How to Submit this Form to Us
Fax the completed form to the Office of Earnings and International Operations (OEIO) at 1-877-268-3827 (preferred for
faster processing). Fax/eFax, mail, or hand-deliver the completed form to your local Social Security office. You can
locate your local office or the dedicated numbers to fax the form electronically (eFax) using Social Security’s Office
locator accessible at https://www.ssa.gov/locator/ (by clicking the “Locate An Office By Zip” button), or by calling us at
1-800-772-1213.

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Form SSA-1694 (XX-XXXX)
Discontinue Prior Editions - Social Security Administration

OMB No. 0960-0731

Privacy Act Statement
Sections 206 and 1631 of the Social Security Act, as amended, allow us to collect this information, which we will use to
identify appointed representatives associated with a business entity as employees or partners, and to facilitate
issuance of appropriate return information for reporting purposes. Providing this information is voluntary, but not
providing all or part of the information may prevent you from serving as an appointed representative and receiving
direct payment of fees from SSA. As law permits, we may use and share the information you submit, including with
employers of claimants’ representatives, contractors, other Federal agencies, and others, as outlined in the routine
uses within System of Records Notice 60-0325, available at www.ssa.gov/privacy. The information you submit may
also be used in computer matching programs to establish or verify eligibility for Federal benefit programs and to recoup
debts under these programs.
Paperwork Reduction Act Statement
This information collection meets the clearance 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 about 10 minutes to read the instructions,
gather the facts, and answer the questions. You may send us your comments on our estimated completion time to
SSA, 6401 Security Blvd., Baltimore, MD 21235-6401.
Send only comments relating to our time estimate to this address, not the completed form.
References
42 U.S.C. §§ 406, 1320a-6, 1383(d)(2) and 1631; 26 U.S.C. §§ 6041 and 6045(f) and 20 CFR §§ 404.1700 et. seq.
and 416.1500 et. seq.

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Form SSA-1694 (XX-XXXX)
Discontinue Prior Editions - Social Security Administration

OMB No. 0960-0731

Entity Registration and Taxpayer Information
Section 1 – Point of Contact Information
First Name/Last Name of Individual Point of Contact (POC) in the Entity (Individual cannot be currently sanctioned by SSA)

Rep ID

Position/Job in the Entity

Phone Number (POC direct line or extension)

Section 2 – Entity Information

This is an Update

Employer Identification Number (EIN)

(Check box if only updating information)

Name of the Business Entity

Tax and Payment Address - P.O. Box, Street, Apt., Suite No. (where check and Form IRS 1099-MISC or -NEC will be mailed)

City

State

ZIP Code (or Postal Zone)

Phone Number (main line)

Fax Number

Section 3 – Entity Banking Information for Direct Deposit
Type of Financial Account:
Banking Institution

Checking

Savings

Money Market

Other

Routing Number

Account Number

Section 4 - Point of Contact Certification and Signature
By signing this form, I certify that I am currently registered as a representative with SSA, I am not currently sanctioned from practicing before
SSA, and I have the authority to act and speak on behalf of the entity to resolve issues relating to fees paid to the entity registering on this
form. By signing this form, I acknowledge that, if the entity takes any action in contradiction of the Social Security Act, agency regulations, or
applicable subregulatory guidance, and either I fail to assist in resolving the issue or act in violation of SSA’s rules of conduct, I may be
suspended or disqualified as a representative before SSA.
I declare under penalty of perjury that I have examined all the information on this form, and it is true to the best of my knowledge.

POC Signature

Date