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SSA Form SSA-1696

Claimant's Appointment of a Representative

What this form is for

Form SSA-1696 officially appoints a representative, such as an attorney, to act for you in your Social Security claim. Once the form is processed, SSA must send your representative copies of notices and decisions, allow them access to your electronic claim file, and deal with them on your behalf at every level, from the initial application through a hearing and Appeals Council review. The form identifies you and your representative, states whether the representative is an attorney, indicates whether a fee will be charged and how it will be approved, and is signed by both of you. Appointing a representative does not slow your claim; it simply ensures the person fighting for you can see the file and meet the deadlines that protect your rights.

How to complete it

Complete the SSA-1696 as soon as you retain a representative, at any stage of your claim. Your representative typically prepares the form; you review it, sign, and date it, and the representative signs to accept the appointment. It can be submitted online through SSA's representative portal, by fax, by mail, or at a field office, and processing registers the appointment in SSA's systems so notices flow to the right place. Fee arrangements are usually handled through a companion fee agreement providing that the representative is paid only if you win, out of back pay, at 25 percent up to the federally set maximum, which is adjusted annually; SSA must approve any fee. To end or change representation later, you or the representative may file a written revocation or withdrawal.

View the official form on ssa.gov

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