We received written notice that [claimant name] has appointed you to act as their representative . Therefore, we will deal directly with you on matters that concern [this claim/these claims.

We have processed your updated direct payment information for the representation of [claimant name].

RSR064 (optional): You have no affiliation with a firm for this claim. you have been identified as a sole proprietor.

RSR063 (optional):We have recorded [firm name] with the EIN […] as your affiliation for this claim.

If you decide to waive your right to a fee or direct payment of a fee, please let us know in a signed writing as soon as possible.

With limited exceptions, we must authorize any fee you charge for your services. You may not charge, collect, or retain more than the fee amount we authorize. To learn more about our fee authorization processes, visit www.ssa.gov/representation.

Important Note: After your appointment ends, you will no longer have access to the claimant’s records or personal information.

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.socialsecurity.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 may 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 written notice that you appointed [representative’s name] to represent you for your claim(s) before the Social Security Administration. Therefore, we will deal directly with [representative’s name] on matters that concern your claim(s), unless you tell us that you did not appoint or intend to appoint this individual.

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.socialsecurity.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.

[Claimant’s name] asked us to revoke your appointment on [date]. We no longer recognize you as the appointed representative for [claimant’s name].

Important Note: After your appointment ends, you will no longer have access to the claimant's records or personal information.

What Happens Next

With limited exceptions, we must authorize any fee you charge for your services. You may not charge, collect, or retain more than the fee amount we authorize. To learn more about our fee authorization processes, To find out how to file a fee petition visit www.ssa.gov/representation/fee_petitions.htm

If You Waive Your Fee

If you wish to waive a fee, you can do so by returning the enclosed waiver as soon as possible.

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.socialsecurity.gov/representation for general information.

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

We no longer recognize [representative’s name] as your representative, because we received a withdrawal request on [date]. This change will not affect how we decide your claim(s) or any other matter that you have before us.

What Happens Next

You may choose to appoint someone else to represent you. Until you decide whether to appoint another representative, we will deal directly with you. We will help you with your claim(s).

[representative’s name] may ask for a fee for services up to the withdrawal date. If the representative who has withdrawn asks for a fee from you, we will let you review the request before we decide the fee amount. The representative may collect the authorized fee directly from you.

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.socialsecurity.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.

We no longer recognize [representative’s name] as your representative, because we received a withdrawal request on [Date]. This change will not affect how we decide your claim(s) or any other matter that you have before us.

What Happens Next

You have appointed other representatives on your claim(s). We have selected [representative’s name] to be your principal representative. However, you may choose to select one of your other representatives to be your principal representative. Until you decide, we will deal directly with [representative’s name].

[Representative’s name] may ask for a fee for his or her services through [date]. If the representative who has withdrawn asks for a fee, we will let you review the request before we decide the fee amount. The representative may collect the approved fee directly from you.

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.socialsecurity.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.

We received written notice that [Claimant Name] has appointed you to act as their  representative. Therefore, we will work directly with you on matters that concern [this claim/these claims].

We have processed your updated direct payment information for the representation of [claimant name].

We have recorded [firm name] with the EIN […] as your affiliation for this claim.

We have also received your request to pay any fee we may authorize for services provided on [this claim/these claims] to [Entity name] ([Entity EIN]). In accordance with agency policy, we will pay the fee authorized directly to [Entity Name].

With limited exceptions, we must authorize any fee you charge for your services. You may not charge, collect, or retain more than the fee amount we authorize. To learn more about our fee authorization processes, visit www.ssa.gov/representation.

(Optional:) Important Note: After your appointment ends, you will no longer have access to the claimant's records or personal information.

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 https://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 could not process the appointed representative forms you submitted for [INSERT: Claimant’s Name] because [INSERT: Claimant’s Name] does not have a matter pending before us or did not have a matter pending before us at the time we received your forms.

If your client intends to file a claim for benefits, an appeal or other matter, or you submitted an iClaim on their behalf, please re-submit your documents once this matter is filed.

Please resubmit your appointment forms after your client files a matter, such as a claim for benefits with us. If you submitted an iClaim on your client’s behalf, please resubmit your appointment forms after the iClaim has been properly signed.

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

We invite you to visit our Representing Claimants website at https://www.socialsecurity.gov to find general information about Social Security. If you have any specific questions, you may call us toll-free

at 1-800-772-1213, or call your local Social Security office at 866-331-2307. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778, 1-800-325-0778 between 7:00 a.m. and 5:30 p.m. Eastern time. You can also write or visit any Social Security office. The office that serves your area is located at:

SOCIAL SECURITY

STREET

CITY, STATE ZIP

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment.

This will help us serve you more quickly when you arrive at the office.

We could not process the request to appoint a representative submitted for [CLAIMANT] because we did not receive a complete, current Form SSA-1696, Claimant’s Appointment of a Representative. If [CLAIMANT] still wishes to appoint a representative, you must submit a complete, current version of Form SSA-1696. The current version of this form is available online in PDF format at https://www.ssa.gov/forms/ssa-1696.pdf. A current electronic version of this form can be submitted through our e1696 portal at www.ssa.gov/representation. Please note that we no longer accept prior versions of this form. For us to process Form SSA-1696, you must submit and ensure the accuracy of all of the following information:

• •

  The claimant's name, Social Security Number (SSN), and signature (Sections 1 and 8);

• •

  The representative's name, Representative Identification Number (RepID), and signature (Sections 2 and 8); and

• •

  The representative’s status and certifications (Section 5, parts A and D).

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).

Need more help?

1. Visit www.ssa.gov for fast, simple, and secure online service.

 

2.  Call us at 1-800-772-1213, weekdays from 8:00 am to 7:00 pm. If you are deaf or hard of hearing, call TTY 1-800-325-0778. Please mention this letter when you call.

3. You may also call your local office [Local FO Telephone number]

SOCIAL SECURITY

STREET

CITY, STATE ZIP

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