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Form 1696 2011-2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. 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.
  3. In Part I, provide the name and address of the individual you are appointing as your representative. You can appoint more than one person if needed.
  4. Check the appropriate boxes for the programs under which you have a claim, such as Title II (RSDI) or Title XVI (SSI).
  5. If you wish to authorize your representative to designate an associate for administrative duties, check the corresponding box.
  6. Sign and date the form at the bottom of Part I, ensuring to include your contact information.
  7. In Part II, have each appointed representative sign to accept their appointment.
  8. Complete Part III regarding fee arrangements. Your representative should select an option that reflects how they will charge for their services.

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Related links

SSA - POMS: DI 12095.115 - 10/18/2011 - Social Security

Oct 18, 2011 — DI 12095.115 Form SSA-1696-U4 (Appointment of Representative). Go to OS 15020.285 to obtain the most current form.

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