Appointment of Representative

OMB 0960-0527

OMB 0960-0527

Recipients use Form SSA-1696 to appoint a representative to handle their claim before SSA. Recipients’ representatives use the Form SSA-1696 to indicate whether they will charge a fee, and, if so, specify their eligibility for direct fee payment. The representatives also use Form SSA 1696 to indicate their disbarment or suspension from a court or bar in which they previously admitted to practice, or their disqualification from participating in or appearing before a Federal program or agency. SSA recognizes the recipient’s representative as the individual named in a notice of appointment (or written statement), which the recipient signed and filed at an SSA office. The SSA 1696 (or written statement) documents the appointment of a representative. We also use this form to collect the business affiliation and EIN of the representatives. Our regulations also require that if the representative is a non attorney, they must sign the form or equivalent written statement. In addition, respondents use the SSA 1696-SUP1 to revoke their appointment of a representative, and representatives use the SSA 1696-SUP2 to withdraw their acceptance of the appointment. SSA uses this information to document the revocation and withdrawal of a representative. Respondents are applicants for, or recipients of, Social Security disability benefits (SSDI); SSI payments; or anyone pursuing a benefit or invoking a right under SSA programs, who are notifying SSA they have appointed a person to represent them in their dealings with SSA, and their non attorney representatives who need to sign the form. This is a non-substantive Change Request to make minor revisions to the form to remove redundancies, and clarify language.

The latest form for Appointment of Representative expires 2022-06-30 and can be found here.

All Historical Document Collections
Approved with change
Revision of a currently approved collection 2022-05-25
Approved without change
No material or nonsubstantive change to a currently approved collection 2021-09-29
Approved without change
No material or nonsubstantive change to a currently approved collection 2021-03-03
Approved with change
No material or nonsubstantive change to a currently approved collection 2021-02-02
Approved with change
No material or nonsubstantive change to a currently approved collection 2020-05-27
Approved without change
No material or nonsubstantive change to a currently approved collection 2019-10-28
Approved without change
Revision of a currently approved collection 2019-03-01
Approved without change
Revision of a currently approved collection 2017-02-20
Approved without change
Revision of a currently approved collection 2013-12-02
Approved without change
No material or nonsubstantive change to a currently approved collection 2011-03-24
Approved without change
Revision of a currently approved collection 2010-10-06
Approved with change
Revision of a currently approved collection 2007-07-05
Approved without change
Extension without change of a currently approved collection 2005-04-21
Approved without change
Revision of a currently approved collection 2004-12-10
Approved without change
Extension without change of a currently approved collection 2004-07-23
Approved without change
Extension without change of a currently approved collection 2003-06-26
Approved without change
Extension without change of a currently approved collection 2000-05-02
Approved without change
No material or nonsubstantive change to a currently approved collection 1999-09-23
Approved without change
No material or nonsubstantive change to a currently approved collection 1998-09-30
Approved without change
Extension without change of a currently approved collection 1997-05-06
Approved without change
New collection (Request for a new OMB Control Number) 1994-01-10
OMB Details

Appointment of Representative - SSA-1696

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SSA-1696Appointment of Representativewww.ssa.govForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.


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