Identification Number:
Intended Audience:RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/OCO-CSTs
Originating Office:DCO OPSOS
Title:Online Form SSA-1696 Claimant’s Appointment of Representative
Type:EM - Emergency Messages
Program:All Programs
Link To Reference:See References at the end of this EM.
Retention Date: February 11, 2022

A. Purpose

This Emergency Message (EM) notifies technicians of a new online service option that representatives and claimants can utilize to complete and sign the form SSA-1696 (Claimant’s Appointment of Representative) electronically through an online portal.

NOTE: This new service option provides an online means of appointing a representative. It does not displace the existing permanent or temporary processes for submitting a completed SSA-1696 or other written notice of appointment.

B. Background

If a claimant decides to appoint an individual to represent him or her in a matter before SSA, the claimant must sign, date, and submit a written notice of appointment to the agency.
The written notice may take any form but most claimants use the agency’s standard form, SSA-1696 Claimant’s Appointment of Representative.

We currently accept the following modes of submission for the written notice of appointment:

    · In person,
    · Mail,
    · Analog Fax,
    · eFax,
    · iAppeals, and
    · Electronic Records Express (ERE) portal (as an upload).
    Due to the COVID-19 pandemic, we have recognized the need to provide additional avenues for claimants to complete and submit the SSA-1696. Additionally, we recognize the need to reduce the number of paper forms coming into our offices and increase the use of technology to process these forms.

    C. Online Service Delivery Option

    Effective Saturday March 6th, 2021, the new online process for completing and electronically submitting the SSA-1696 forms will be available on our agency internet website at Once the prospective representative and the claimant complete their respective sections, electronically sign, and submit the online form, an image of the completed form will be electronically transmitted to the claimant’s local field office online work queue system for a field office technician to process the form.

    NOTE: Due to SSA network restrictions, SSA employees cannot access the online SSA-1696 portal to access or view pending submissions.

    D. Online Completion Guidelines

    The online form will require both the prospective representative and the claimant to complete their respective portions of the SSA-1696.

    The prospective representative initiates the online SSA-1696 process. The prospective representative must first enter the email addresses for both themselves and the claimant. The prospective representative will be required to create a password for themselves and the claimant to use in order to access the form, which will be sent via an email link from Adobe. The prospective representative must provide the password to the claimant either by phone, in person, or SMS text message. If the representative is unable to contact the claimant by those means, he or she may send the password via a separate email message.

    NOTE: Technicians will NOT have access to the password and CANNOT reissue a password. Technicians will never ask a prospective representative or a claimant for their password. The password is between the prospective representative and the claimant ONLY.

    The claimant and the prospective representative have five calendar days from the date the prospective representative clicks the “Submit” button on the email collection page to complete, electronically sign, and submit the SSA-1696 online form to SSA.

    If the claimant does not complete, electronically sign, and submit the form to SSA within five calendar days from when the prospective representative clicks the “Submit” button on the email collection page, the system will lock the form and it cannot be reactivated. At this point, the prospective representative will need to start a new form or submit a new notice of appointment through any of the modes described in Section B.

    Phase 1: Prospective Representative

    · The prospective representative begins the Form SSA-1696 Online process by providing and confirming email addresses for both the representative and the claimant.

      NOTE: The prospective representative cannot proceed with the online process unless they provide and confirm a properly formatted email address for both parties.

    · The prospective representative will also create a password from 8-32 alphanumeric characters in length that will require at least one upper case and lower case letter, and one number. No special characters are required. The representative must share this password with the claimant outside of the Form SSA-1696 Online process. The prospective representative or the claimant must use this password whenever either party attempts to open a copy of the SSA-1696 from the link distributed via email.
      NOTE: SSA employees will not have access to the password. This is a matter between the claimant and the representative. The password is unique to a single SSA-1696 transaction, and cannot be reset or recovered. The prospective representative will need to restart the application process if the password is lost or forgotten.
    · After providing the email addresses, the representative will receive an on-screen message directing him or her to open the email sent from Adobe sign.
    · The email will include a “Review and Sign” button that, when selected, will direct the representative to enter their password-protected online SSA-1696 form for completion. (All required fields for the representative will be highlighted with asterisks.)
      Once the prospective representative completes all required fields, and electronically signs the form, he or she will select “Click to Sign” to complete their portion of the form.
      NOTE: The online process will not allow the prospective representative to submit the form without completing all required fields and electronically signing the form.
    · The system then generates an email to the claimant at the email address provided, with a link to complete the remainder of form for Phase 2 of the online appointment process.

    Phase 2: Claimant
      · The claimant will receive an email from Adobe sign with a link to complete the remainder of the form.
      · The claimant will use the password created by the prospective representative to access the remainder of the form.
      · The claimant will have an opportunity to review the information filled out by the prospective representative.
        IMPORTANT: Each respective party will not have the ability to key in information in the other party’s section, or revise what has been submitted. For example, the claimant will not be able to change the information that was previously filled out by the representative. If the claimant disagrees with any information completed by the representative, the claimant should not proceed with the online appointment process. If the claimant still wants to appoint the representative and inquires with SSA, you must advise the claimant that he or she should contact the representative to initiate a new, accurate, online SSA-1696.
      · The claimant will complete the highlighted fields to finish the form.
      · The claimant will sign the form and select “Click to Sign”.
      · The claimant will receive a message on screen the Form SSA-1696 Online form has been completed. The message will contain a link to download a copy of the form so the claimant is able to review the completed and electronically signed form.
      · A final email will be automatically generated from Adobe sign to both the prospective representative and the claimant confirming that their submission is complete. The email will include a link to view and download the completed SSA-1696 form. The password will be required to view and access the completed form.
      E. FO Processing Guidelines

      Once the claimant has reviewed, completed, signed, and submitted the online SSA-1696, the system will electronically route an image of the completed form to WorkTrack for processing, using the claimant’s zip code provided on the submission to identify the claimant’s local field office.

      WorkTrack will list the Online Form SSA-1696 submission as unassigned. Follow current processing guidelines for handling the SSA-1696 in GN 03910.040 (Appointment of a Representative). You must:

      · Check to make sure there is a pending and/or active claim.
      · Verifying the representative meets the approved standards outlined in GN 03910.020

      IMPORTANT: We cannot accept a notice of appointment unless there is a claim or other matter pending decision before SSA. Further, the notice of appointment or SSA-1696 is not the mode for an address change. Based on this –

      a. If you determine that there is no pending claim, you cannot process the submission and must notify the parties. Use UTI REP028 in DPS.
      b. If the claimant’s address is different in the claim file, or another office has jurisdiction of the pending claim, the document was misrouted. You must identify the claim’s pending location (i.e. WSU, DDS, OHO, etc.), route the form to the proper location, and send the correct notifications.

      NOTE: If you have questions about the submission, contact the representative. If you need to contact a represented claimant and the situation potentially falls under an exception, make sure to follow policy in GN 03910.050 regarding when and how to do it.

      NOTE: The signature date for the Registration, Appointment and Services for Representatives (RASR) application will be the claimant’s date on the online SSA-1696.

      Direct all program and technical related questions to your Regional Office (RO) support staff or Program Service Center (PSC) Operations Analysis (OA) staff. RO support staff or PSC OA staff may refer questions, concerns or problems to their Central Office contacts.


      GN 03910.040 Appointment of a Representative

      GN 03910.050 Contacting a Represented Claimant

      GN 03910.020 Qualifications for and Recognition of Representatives

      GN 03910.060 When a Representative’s Appointment Ends

      EM-21021 - Online Form SSA-1696 Claimant’s Appointment of Representative - 03/15/2021