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  • Ssa-1696-u4 2011

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(e.g. a clerk), or other party or entity (e.g. a copying service) to receive information from your claim file on your representative's behalf for the duration of your claim. If you want to give your representative permission to do that, check the block to authorize this release. If you will have more than one representative, check the appropriate block and give the name of the individual you want to be your main representative. You must sign and date the form. Print or type your address, area c.

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Related content

Form SSA-1696 | Appointment of Representative...
“Us” and “SSA” means the Social Security Administration. General Information About...
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Appointment of Representative
Sections 206(a) and 1631(d) of the Social Security Act, as amended, authorize us to...
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Social Security Form SSA-1696-U4 is a form that allows you to appoint a third party to represent you when you deal with the Social Security Administration (SSA). You can choose to have an attorney as your representative or you can appoint any qualified individual you wish.

The law defines disability as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

You may authorise a person to represent you and act on your behalf in relation to your application. This person is known as your representative. It is not necessary to nominate a representative you may choose to deal with us directly.

Name of claimant. Social security number. Wage earner. Social security number. Part 1 - Claimant's Appointment of Representation. Name of individual. ... Part 2 - Representative's Acceptance of Appointment. Name. ... Part 3 - Fee Arrangement. ... Signature.

Key Takeaways. Social Security benefits provide partial replacement income for qualified retirees and disabled individuals, as well as for their spouses, children, and survivors. An individual must pay into the Social Security program during their working years and accrue 40 credits in order to qualify for benefits.

Form SSA-1696 is used by the Social Security Administration (SSA) to document your appointment of a representative in your dealings with the SSA. ... In addition to formally establishing the claimant-representative relationship, Form SSA-1696 indicates whether your representative is charging a fee for services.

Use SSA Resources You can make an appointment by calling 1-800-772-1213 or you can stop by your local office. ... Someone else can apply on your behalf and the SSA will follow up with you to obtain signatures and consents for filing your claim.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
SSA-1696-U4
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