Get Ssa-1696-u4 2011

Filling out the SSA-1696-U4 form is an important step in appointing a representative for your Social Security matters. This guide provides a comprehensive walkthrough to help you complete the form online with confidence.

Follow the steps to fill out the SSA-1696-U4 form accurately.

1. Click ‘Get Form’ button to obtain the SSA-1696-U4 form and open it in your editor.
2. At the top of the form, enter your full name and Social Security number. If your claim is based on another person’s work, include the wage earner’s name and Social Security number.
3. In Part I, appoint your representative by providing their name and address. You can appoint an attorney or another qualified individual.
4. Indicate the program(s) under which you have a claim by checking the appropriate boxes: Title II (RSDI), Title XVI (SSI), Title XVIII (Medicare Coverage), or Title VIII (SVB).
5. If you wish to allow your representative to designate an associate for administrative duties, check the appropriate box.
6. Include the name of your primary representative if you have appointed more than one representative.
7. Sign and date the form and provide your address and phone number.
8. In Part II, your appointed representative must complete the acceptance section, confirming their eligibility to represent you.
9. In Part III, discuss the fee arrangement with your representative. They should select the relevant option regarding fees and sign the section.
10. After completing the form, save the changes, download, print, or share the SSA-1696-U4 form as needed.

Complete your SSA-1696-U4 form online today to ensure your representation is properly established.