Omb 0960 0527-2026

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The document is a form from the Social Security Administration (SSA) titled 'Appointment of Representative' which allows a claimant to appoint a representative to act on their behalf regarding various Social Security claims. It outlines the responsibilities and powers of the appointed representative, the process for fee agreements, and the conditions under which fees can be charged. The form includes sections for the claimant's information, acceptance of appointment by the representative, and optional waivers regarding fees. Additionally, it provides guidance on what representatives may do and how they may charge for their services.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name and Social Security number at the top of the form. If applicable, include the wage earner's name and Social Security number.
In Part I, appoint your representative by providing their name and address. Check the relevant program boxes (e.g., Title II for RSDI, Title XVI for SSI) that pertain to your claim.
Sign and date the form in the designated area to confirm your appointment of the representative.
In Part II, have your appointed representative complete their acceptance of appointment by signing and providing their contact information.
If applicable, complete Parts III and IV regarding fee waivers or direct payment waivers as needed.
Review all entries for accuracy before saving or exporting the completed form from our platform.

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