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F120-212-000 Legal Representative Payment Method Authorization 05-2017. Return completed forms to: PO Box 44834.Download Legal Representative Payment Method Authorization Form (F120-212-000) – Department of Labor and Industries (Washington) form. Fill out the Payment Method Authorization form (F120-211-000). The claim number and type of payment are printed on Government. Form SSA-1699 (09-2013). Write or type the required information on the hardcopy and authorize the form, if applicable, with a hand-written signature. Electronic or stamped signatures won't be accepted. You can complete Form POA1 using our web application, accessible from your Online Services account. Complete for ANY non-employee payee receiving payments: Non-Employee Claimant (not a current or former employee).