In order to link a claimant to an appointed representative on the ARDB, the representative
must submit a Form SSA-1695 with each claim. The information from a Form SSA-1695,
submitted in connection with a Title II and/or Title XVI claim, and the appointment
document is entered through the Payment Outside Title II System (POTS) and passed
to the claim system that is processing the claim. If the Form SSA-1695 is received
with the appointment of representative and the link is established before the representative’s
address, etc., is keyed into the claim system, that information will propagate from
the ARDB to the claim record, and thus eliminate manual keying.
If address information manually entered into the claim system differs from the information
on the ARDB, the information on the ARDB will overlay what was entered manually into
the claim system.
Complete Form SSA-1695 (Identifying Information for Possible Direct Payment of Authorized
Fees) – The representative must submit this paper form in connection with each claimant
he or she represents. SSA uses this information to establish a link between the claimant
and the representative on the ARDB. This link enables the information on the ARDB
to propagate to the Title II and/or Titles XVI claims record. Because each link is
established separately, when multiple representatives are appointed concurrently in
one claim, SSA must secure a separate SSA-1695 from each co-representative who is
eligible to receive, and who is or will be requesting direct payment, even when all
co-representatives are members of the same firm. The form asks for the following information
(see GN 03910.090 for the form):
Name of Claimant and SSN.
Wage earner’s (w/e) name if different and w/e SSN if different.
Representative’s name, SSN, address, phone number, and FAX number.
EIN, if represent claimant as a partner or employee of firm or other business entity.
Information about other claimants connected with this claim (optional).
NOTE: Once you have successfully entered Form SSA-1695, Identifying Information for Possible
Direct Payment of Authorized Fees, send the acknowledgement notice to the appointed
representative. This notice must be sent. (See DPS (Document Processing System) or
GN 03910.090 for an exhibit of the notice.)