Identification Number:
EM-12004 REV 5
Intended Audience:All RCs/ARCs/ADs/DDSs/FOs/PSCs/
Originating Office:ORDP ODP
Title:New Procedures for Form SSA-1695 – Identifying Information for Possible Direct Payment of Authorized Fee
Type:EM - Emergency Messages
Program:All Programs
Link To Reference:See References at the end of this EM.
Retention Date: June 30, 2022

Retention Date: March 1, 2019
Retention Date: December 19, 2016.
Retention Date: May 18, 2016.

Revised Retention Date: May 18, 2015.
Retention Date: February 28, 2015.
Retention Date: August 29, 2014.

REVISION 03/01/2018: We are revising EM-12004 REV 3 to update the processing steps of the form SSA-1695 (Identifying Information for Possible Direct payment of Authorized Fee) as they will take place in RASR. We are also updating the Office of Hearings organizational name to OHO from ODAR (as previously known, Office Disability Adjudication and Review).

A. Purpose

This revision to the emergency message (EM) revises some of the procedural steps in of the SSA-1695 after implementation of RASR, changes ODAR to OHO and includes an important reminder for DDS and all OHO offices.

B. Background

We currently send acknowledgment notices to representatives after we complete processing of Form SSA-1695.These notices are manual. We also fax the processed SSA-1695 into the electronic folder (EF) to maintain a record of the original.

C. New procedures

We are revising this EM policy to reflect that effective immediately, we will no longer send manual acknowledgement notices to representatives after processing the SSA-1695, since RASR release 1 will send this notice automatically. In addition, we will no longer redact and fax the processed SSA-1695 into the electronic folder (EF). Instead,we will properly dispose of the form, since the acknowledgement notice sent automatically by RASR will serve as our record of the processing.

When the DDS or OHO receives an SSA-1695:
      • DDS and OHO offices do not process Form SSA-1695s.
      • These offices must send the SSA-1695 immediately to the claimant’s servicing FO for processing.
2. When the FO or PC receives an SSA-1695:
      a. Verify that a valid appointment exists and that SSA has not already effectuated a favorable decision.
      b. Enter data from SSA-1695 into RASR screens.
      c. Destroy the form after entering the data successfully in RASR.

      NOTE: Refer to GN 03920.055 if the representative timely submitted an SSA-1695, but we inadvertently released the withheld past-due benefits.

      NOTE: Do not Fax the SSA-1695 into the PC’s Paperless Processing Center System (PPC) under any circumstances.
    3. If an “un-masked” (i.e., one showing the representative’s SSN) or “partially masked” (i.e., showing one or more digits of the SSN) SSA-1695 appears in the electronic folder (EF), follow directions in DI 81010.090 (FOs) or DI 80830.100 (PCs) to move the un-masked or partially masked form to the current green development/temp section C in the EF.

    4. If an SSA-1695 has not been processed when you are ready to effectuate a favorable decision, but there is an SSA-1696 or written equivalent from a representative requesting direct fee payment, and the representative is eligible for direct fee payment, you must:

      · Contact the representative;

      · Inform the representative that SSA has not received the SSA-1695;

      · Instruct the representative to fax the SSA-1695 to you immediately, if the representative wants direct payment.
      NOTE: You should try to establish the link before effectuating the claim.

    Direct all program-related and technical questions to your RO support staff or PC OA staff. RO support staff or PC OA staff may refer questions or problems to their Central Office contacts.

    DI 80630.010 Electronic Folder (EF)
    DI 80640.020 Electronic Folder (EF)
    DI 80650.050 Scanning
    DI 80830.030 Using Information in the Electronic Folder (EF)
    DI 80830.100 Barcodes
    DI 80850.055 Barcodes
    DI 80850.060 Scanning
    DI 81010.090 Faxing Documents into the Certified Electronic Folder (CEF) Using Barcodes
    GN 03910.042 Forms 1099-MISC and Employer Registration
    GN 03920.017 Payment of Representative's Fee
    GN 03920.055 Benefits Not Available to Certify Direct Payment to a Representative
    EM-12004 REV 5 - New Procedures for Form SSA-1695 – Identifying Information for Possible Direct Payment of Authorized Fee - 03/05/2018