Attention: [Entity POC Name] (Entity POC)

[Rep Name] has requested that [Entity Name] receive direct payment of any fee we authorize for services provided on [Claimant Name (possessive)] claim(s).

We processed this assignment request. We will pay the fee due for services provided on this claim directly to [Entity Name] in accordance with [Rep Name (Possessive)] request and agency policy. It is important to keep registration information up to date to ensure accurate payments and continuing eligibility for direct payment. Use Form SSA-1694, Entity Registration and Taxpayer Information, to update [Entity Name (Possessive)] records with us.

Suspect Social Security Fraud?

If you suspect Social Security fraud, please visit http://oig.ssa.gov/r or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

If You Have Questions

Please visit our Representing Claimants website at www.ssa.gov/representation for general information.  

If you have questions, please call us at 1-800-772-6270. If you are deaf or hard of hearing, you can call the TTY number, 1-800-325-0778 between 7:00 a.m. and 5:30 p.m. Eastern time, Monday through Friday. When you call, please have this letter with you to help us answer your questions.

If you have questions about reporting income or Form 1099-MISC, please contact the Internal Revenue Service.

Attention: [Entity POC Name] (Entity POC)

We previously notified you that we had processed [Rep Name (Possessive)] request to assign to [Entity Name] ([Entity EIN]) direct payment of any fee we authorize for representational services [Rep Name] provided in [Claimant Name (Possessive)] claim.

We now write to notify you that [Rep Name] has rescinded that assignment. 

A representative may rescind an assignment at any time prior to the date we notify the claimant of the first favorable determination or decision in their claim. We will honor the representative’s request to rescind an assignment if it is made timely and otherwise complies with our rules.

Because the request to rescind the assignment was timely and otherwise complied with our rules, we have processed it and we will not pay [Entity Name] any fee we authorize for representational services [Rep Name] provided in [Claimant Name (Possessive)] claim.

Please do not contact us regarding this issue. If you have questions, contact [Rep Name]. 

Suspect Social Security Fraud?

If you suspect Social Security fraud, please visit http://oig.ssa.gov/r or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

If You Have Questions

Please visit our Representing Claimants website at www.ssa.gov/representation for general information.   If you have questions, please call us at 1-800-772-6270. If you are deaf or hard of hearing, you can call the TTY number, 1-800-325-0778 between 7:00 a.m. and 5:30 p.m. Eastern time, Monday through Friday. When you call, please have this letter with you to help us answer your questions.  

If you have questions about reporting income or Form 1099-MISC, please contact the Internal Revenue Service.

We received your request to assign direct payment of any authorized fee to [Entity Name], but we are unable to honor your request for at least one of the following reasons:

• •

  the request was incomplete;

• •

  the request was not timely;

• •

  this entity is not properly registered;

• •

  you are currently ineligible to receive direct payment;

• •

  this entity is currently ineligible to receive direct payment; or

• •

  your request does not otherwise comply with our rules for assigning direct payment of an authorized fee.

Unless we receive a valid assignment request, we will pay the authorized fee to you, consistent with our policy, if you are eligible to receive direct payment at the time of payment.   If an ineligible entity becomes eligible for direct payment before we notify the claimant of our first favorable determination or decision in this case, you may resubmit your request to assign direct payment of your fee to this entity.

Suspect Social Security Fraud?

If you suspect Social Security fraud, please visit http://oig.ssa.gov/r or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

If You Have Questions

Please visit our Representing Claimants website at www.ssa.gov/representation for general information.   If you have questions, please call us at 1-800-772-6270. If you are deaf or hard of hearing, you can call the TTY number, 1-800-325-0778 between 7:00 a.m. and 5:30 p.m. Eastern time, Monday through Friday. When you call, please have this letter with you to help us answer your questions.

If you have questions about reporting income or Form 1099-MISC, please contact the Internal Revenue Service.