Description:
The form "Appointment of Representative" [SSA-1696-U4] is required when an individual chooses to have another person (usually an attorney), provide assistance when there is a dispute with the Social Security Administration (SSA) such as a disability claim. Once appointed, the representative may act for you in most Social Security matters. This includes getting information from your claims file; giving evidence of information to support a claim; appear for conferences, hearings or reviews; and help you prepare for a hearing and question witnesses. The representative receives a copy of SSA decisions. The SSA will continue to work with the appointed representative until the SSA is informed the person no longer represents you or the representative informs SSA s/he is withdrawing or his/her services have ended.
A copy of the "Appointment of Representative" form can be obtained from the Social Security Administration or downloaded from the Social Security Administration internet website. A link to a fillable form can be found on the contact information tab on this web page.
THE "APPOINTMENT OF REPRESENTATIVE" form IS NOT A "REPRESENTATIVE PAYEE" form.
The "Appointment of Representative" form can be used for Medicare (Title XVIII); SSI (Title XVI); Black Lung (Title IV FMSHA); RSDI (Title II); and SVB (Title VIII) claims.
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