Establishing Representative Role: Completing Form SSA-1696

SSA-1696: Claimant's Appointment of Representative

Completing the SSA-1696: Appointment of Representative form is very important so that both SSA and DDS can communicate with you about the application and ask any questions that they might have. This article walks you through the form and provides tips for its completion. This form is submitted to SSA as part of the complete application packet. 

Registering as a Representative with SSA

All individuals who wish to represent someone before the Social Security Administration must register as representatives using the SSA-1699: Representative Registration. This includes all SOAR providers who will submit the SSA-1696 to represent SSI/SSDI applicants. Read more about Representative Registration.

Completing the SSA-1696 Form

Starting on page 4, provide the claimant’s Social Security Number (SSN) and your Representative Rep ID across the top of each page.

Section 1 – Reason for Submission and Claimant's Information

• Reason for Submission: SOAR providers should select "Appoint a new Representative" when working with a new applicant.
• Claimant's Information: Provide the applicant's name and SSN.
• Number Holder's Information: If the claim is based on another person’s work or earnings (such as those from a spouse or parent), provide the other person’s Social Security number and name. If not, you can leave this blank.

Section 2 – Representative's Information

• Provide your name and Registered Representative Rep ID number. 

Section 3 – Claimant's Principal Representative

• If you are the only representative for the claimant, this section can be left blank.
• If the claimant has or wants to have more than one representative, add the name of the principal representative here. Only the person named as the principal representative will receive copies of communication sent from SSA to the claimant.

Section 4 – Claim Type

• For most SOAR-assisted adult SSI/SSDI applications, you will check the first two boxes: 
  • “Claim/Appeal for Title II Disability Benefits.” Title II (also known as RSDI) is Retirement, Survivors, and Disability Insurance, and SSDI is part of this program.
  • “Claim/Appeal for Title XVI Disability Benefits.” Title XVI is the Supplemental Security Income (SSI) program.
• In special circumstances, the claimant may need representation for future matters, such as a Continuing Disability Review (CDR) or an overpayment. When appropriate, you can check those boxes. 
• If approved for SSDI, the claimant will not need special representation for Title XVIII (Medicare) to be eligible for it. Title VIII (Special Veterans Benefits (SVB)) is applicable only to certain WWII Veterans living abroad. It is unlikely you will need to provide representation for these matters.

Section 5 – Representative’s Status, Affiliations, and Certifications

• Part A - Representative’s Status, Disqualifications, or Suspensions: Check the box appropriate to your circumstance. Most SOAR case workers are not attorneys and will select, “I am a non-attorney not eligible for direct payment.” 
• Part B - Representative’s Affiliation and Part C - Assignment of Direct Payment of Authorized Fee to an Entity: These questions only apply to those who are seeking a fee. Since you will not be seeking a fee for SOAR assistance, these will be left blank.
• Part D - Representative’s Certifications: At the bottom of Section 5, sign with your initials to certify that you accept the appointment and will comply with SSA’s rules of conduct for representatives.

Section 6 – Fee Arrangement

• Select the last box: “I waive the right to a fee.” 
• SOAR providers do not charge SSI/SSDI applicants for their services. We work closely with providers to identify alternative sources of funding for their programs.

Section 7 – Other Claimants

• List other claimants related to this application including a child, parent, or spouse. 

Section 8 - Signatures

• Both the claimant and the representative will need to sign and date the form.
• Note:  Signatures must be completed in ink. (Electronic signatures are only accepted for the purposes of the SOAR Online Course).

Completing the SSA e-1696

The SSA-1696 can also be completed electronically on the SSA website. The e-1696 is a two-step online process that captures the electronic signatures of both the prospective representative and claimant without any personal contact. The representative (i.e., the case worker) must initiate the process. Once the claimant completes the second step and submits the e-signed document, the service will automatically route the document for processing. 

While the electronic submission of the form is convenient and provides flexibility, case workers should evaluate whether the applicant they are representing can complete the process. The claimant must have a valid email address (they cannot use yours) and must have the computer skills necessary to open the email they will receive from SSA, complete and sign the form electronically, and submit to SSA.

If these submission requirements for the SSA e-1696 are unable to be met due to the applicant’s circumstances, case workers should submit the paper version of the form as part of the complete SSI/SSDI packet. Click here for step-by-step instructions on completing the new SSA e-1696.

• Sample Completed SSA-1696