Basic (12-19)

GN 03905.030 Forms SSA-1696 Appointment, Revocation, and Withdrawal

A. When to use

A claimant must notify us in writing (e.g., Form SSA-1696 or "equivalent writing") if he or she appoints an individual to represent him or her in dealings with us. A claimant must also let us know in writing when he or she wants to revoke a representative's appointment. Likewise, an appointed representative must notify us in writing when he or she wants to withdraw from an appointment. Claimants and representatives have these options to use our forms for their actions.

B. Exhibits

1. Form SSA-1696 Claimant's Appointment of a Representative

See Form SSA-1696 to obtain the most current PDF.

2. Form SSA-1696-SUP1 Claimant's Revocation of the Appointment of a Representative

See Form SSA-1696-SUP1 to obtain the most current PDF.

3. Form SSA-1696-SUP2 Representative's Withdrawal of acceptance of an Appointment

See Form SSA-1969-SUP2 to obtain the most current PDF.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203905030
GN 03905.030 - Forms SSA-1696 Appointment, Revocation, and Withdrawal - 12/10/2019
Batch run: 12/12/2019
Rev:12/10/2019