PolicyNet/Instructions Updates/EM-20022 REV 3: Temporary Instructions for the Bundled Receipt and Processing of an Electronically Signed SSA-1696 and Certain Other Forms

Effective Dates: 11/12/2021 - Present

Identification Number:	EM-20022 REV 3
Intended Audience:	All RCs/ ARCs/ ADs/ FOs/ TSCs/ PSCs/ OCO/ OCO-CSTs/ OHO/ OARO
Originating Office:	DCO OPSOS
Title:	Temporary Instructions for the Bundled Receipt and Processing of an Electronically Signed SSA-1696 and Certain Other Forms
Type:	EM - Emergency Messages
Program:	Title II (RSI); Title XVI (SSI); Title XVIII (Medicare)
Link To Reference:	See References at the end of this EM.

Retention Date: June 13, 2024

Revision Statement: This EM replaces the prior version published on March 11, 2021.

Summary of Revisions:

Section A – Added clarifying language.

Section B – Clarified language regarding receipt of the e1696 and added reference to. EM 21021 REV

Section C – Clarified language for the readability of the document and added a note providing instructions for forms received with a blank signature.

Section C.1. Added clarifying language for readability of the document.

Section C.2.– Replaced POMS reference GN 03360.005A.1 with GN 00203.020 A.2.b. Also added mention of instructions for the e1696 and link to. EM 21021 REV

Section C.4 – Removed POMS reference GN 00201.015.

Section C.5 – Added clarifying language for readability of the document including a note to use an MDW to document contact attempts when MCS/MSSICS is not available. Also replaced POMS reference GN 00201.010 with GN 00204.012.

Section D – No changes.

Section E – No changes.

Section F – Added additional references.

A. Purpose

The purpose of this EM is to provide Field Offices (FO), Payment Centers (PC), and the Office of Hearings Operations (OHO) with temporary supplemental instructions for documenting the appointment of a representative and fee agreement, if appropriate, and the actions to take when we receive certain forms with the appointment. These instructions are applicable while the EM is in effect.

These instructions apply when the FO or PC process a notice of appointment of a representative, revocation of an appointment, withdrawal of acceptance of an appointment, representative fee agreement, representative payment information, and other forms received with the SSA-1696. Additionally, these instructions provide OHO with temporary guidance for a representative’s appointment via on-the-record attestation when needed during remote telephone and online video hearings.

These temporary instructions, while in effect, replace our subregulatory wet signature requirement for the written notice of appointment (i.e., SSA-1696 or other written notice of appointment) and the fee agreement.

B. Background

Our regulations require the claimant to submit a signed written notice of appointment to appoint a representative (See 20 CFR 404.1707 and 416.1507). GN 03910.040 requires that the claimant’s signature on the notice of appointment “must be in ink.” Our subregulatory guidance also requires that the claimant use a wet signature on his or her fee agreement. GN 03940.003.

We currently accept copies of the notice of appointment and other representational documents in person, as well as by mail, analog fax, eFax, and the iAppeals, and Electronic Records Express (ERE) portals. We also accept the online SSA-1696 submission (e1696) via the Adobe Sign business process.

Follow the instructions in this EM if any of the forms listed in Section C are accompanied by an electronically signed SSA-1696 (this includes a completed e1696). Submissions of a notice of appointment through the e1696 portal do not require further verification of the signature. See EM 21021 REV for background regarding the e1696.

NOTE: Representatives and other individuals can find dedicated numbers to fax their documents electronically (eFax) using Social Security’s Office locator accessible at https://www.ssa.gov/locator/ (under the “Locate An Office By Zip” tab), or by calling us at 1-800-772-1213. Technicians (e.g., N8NN agents) can also locate these numbers in the Detailed Office/Organization Resource System (DOORS).

C. FO and PC Temporary Instructions

While this EM is in effect, use the instructions below if any of the forms are submitted without a signature the agency would otherwise recognize as valid, so long as such forms are accompanied by an electronically signed SSA-1696:

SSA-1693 Fee Agreement for Representation before SSA (or other written fee agreement)

SSA-16 Application for Disability Insurance Benefits

SSA-8001 Application for Supplemental Security Income (SSI) (Deferred or Abbreviated)

SSA-8000 Application for Supplemental Security Income (SSI)

SSA-L2 Comprehensive Notice and Application Summary for Third Party Filed iClaim

SSA-820 Work Activity Report – Self-Employment

SSA-821 Work Activity Report - Employee

SSA-827 Authorization To Disclose Information To The Social Security Administration

SSA-455 Disability Update Report

If a representative submits any of the above forms along with an electronically signed SSA-1696, technicians will take all steps, during a single telephone contact with the claimant, for each form submitted.

NOTE: If you receive an application with a blank signature (as opposed to an application with an electronic signature), contact the claimant and follow GN 00201.015 to complete attestation. If you are unable to obtain attestation, follow GN 00204.012 E and F to issue a closeout notice.

If SSA received only the SSA-1696 and other representational documents (e.g., the fee agreement) go to Steps 2 and 3 in this section.

Complete attestation for claims application forms submitted along with an electronically signed SSA-1696

Complete the proper attestation for the application form(s) using the current attestation process (SSA-16, SSA-8000, SSA-8001, SSA-L2) and then obtain verbal confirmation of the electronic signature for the SSA-1696 (see C.3 for the fee agreement/SSA-1693).

Technicians must attempt to contact claimants up to three times. If contact is successful, follow the steps below to obtain the proper attestation for the forms:

1. Follow GN 00203.020 to verify the claimant’s identity;

2. Follow

GN 00201.015F.3.a

to start the attestation process;

3. Verify the information in the benefit application forms (see GN 00204.055H.2.b for third party initiated iClaims);

4. Verify the information in the additional forms listed above; and

5. Follow

GN 00201.015F.3.c

and F.6.a to complete the attestation process.

Once the attestation process is completed, continue to obtain verbal confirmation of the signature for the written notice of appointment by following instructions in section C.2 of this EM.

IMPORTANT: If the claimant indicates that he or she does not want to file for benefits or does not want to verify the information for attestation, return all the forms and notice of appointment to the party who submitted them. In addition, for non-iClaim situations, mail a closeout notice directly to the claimant for the protective filing date created by the submitted benefit application, per the instructions in GN 00204.012. If you suspect fraud is involved, complete a fraud/misconduct allegation in the Allegation Referral Intake System (ARIS). When completing the ARIS referral, select “Fraud Category” and report the behavior as “Appointed Representative Misconduct.”

If contact is unsuccessful after the first attempt, follow section C.5.c of this EM to document attempts and send a call-in letter.

New notice of appointment of a representative submitted (with or without forms listed in section C)

If the claimant’s signature on a notice of appointment (i.e., Form SSA-1696 or another written notice) does not meet the agency’s current signature requirements in

GN 03910.040

(e.g., signature appears to be electronic), follow the instructions below:

IMPORTANT:

Apply the following workflow to new appointments whether received in person or via mail, fax, eFax, iAppeals, or ERE.

EXCEPTION:

If OHO has jurisdiction of the claim, check with OHO staff to determine if OHO already held a hearing for the case and the appointment was verified on-the-record (OTR). If the ALJ verified the appointment for this representative on the record during the hearing,

do not call the claimant to seek verification of the signature on the written notice of appointment

. Process the appointment, add the Representative Flag in the Electronic Disability Collect System (EDCS), perform an Update after Transfer (UAT), and notify the hearing office that we have received the claimant’s appointment.

Contact the claimant up to three times to confirm his or her electronic signature on the notice of appointment. First, verify the claimant’s identity following these steps:

i. Check the SSR/MBR and FO records for a current number and contact the claimant by telephone.

ii. Identify the claimant using questions in GN 00203.020 A.2.b

If you receive the Form SSA-1696 with the claimant’s electronic signature:

Confirm the claimant’s signature and intent to sign the SSA-1696 using the following script:

i. “We have received an appointment form with your electronic signature and need to ask you a few questions to confirm your signature. Did you sign this form?”

ii. “And you understood that by electronically signing this notice of appointment, you agreed that [insert name of Appointed Representative on the SSA-1696] will now represent you for your claim with SSA, and [he/she] and [his/her] employees can obtain information about your claim from SSA?”

NOTE

: An e1696 does not need to be verified. See.

EM 21021 REV

c. If you receive a written appointment notice (other than the SSA-1696) that contains the claimant’s electronic signature:

The SSA-1696 is not required. We continue to accept other written notices.

Confirm the claimant’s signature and intent to sign the notice of appointment using the following scripts:

i. “We have received your written notice of appointment with your electronic signature and need to ask you a few simple questions to confirm you signed it. Did you sign this writing?”

ii. “And you understood that by electronically signing this notice of appointment, you agreed that [insert name of Appointed Representative listed] will now represent you for your claim with SSA, and [he/she] can obtain information about your claim from SSA”?

NOTE

: Follow existing procedure to process the SSA-1696 or other written notice and to recognize the appointment.

Fee Agreement submitted with new electronically signed representative appointment

If a new appointment and fee agreement are submitted together and the claimant’s signature is identical on both documents, accept the fee agreement with no additional verification only if the claimant verbally confirmed the signature on the notice of appointment, or during a telephone hearing per C.2. above.

If you receive other forms listed in this EM (e.g. SSA-820, SSA-821, SSA-827, SSA-455) with the electronically signed SSA-1696 (and the form(s) are also electronically signed by the claimant):

Use existing attestation procedures for the specific form(s) received and develop the claim or issue following existing policy.

NOTE:

Follow the instructions in EM-20029 for the SSA-455, as currently there are no permanent attestation instructions for this form.

Documentation Instructions

If you obtain verbal confirmation of the signature on the notice of appointment and attestations on any additional forms submitted with the notice of appointment:

i. Add the appointment to the claim using Registration, Appointment and Services for Representatives (RASR) for those representatives who are registered or upload to eView for those who are not registered. Use the date the claimant electronically signed the notice of appointment per

GN 03910.040

. If the claimant did not date the document or if the date is not part of the electronic signature, use the date received (whether mailed, faxed or uploaded).

ii. Complete the Report of Contact (ROC) feature in RASR using the following language:

“Claimant’s electronic signature on the written notice of appointment. Properly identified claimant and verified signature, including intent to electronically sign, via telephone on MM-DD-YY”.

iii. For appointments processed outside RASR (i.e., the representative is not registered), document contact using the same language in 5.a.ii. on an SSA-5002 ROC and add to the claim folder as appropriate.

iv. RASR sends a notice to both the claimant and representative confirming the processing and recognition of the appointment. For the appointments processed outside RASR, follow existing procedure (i.e., send manual notices).

If you contact the claimant, but the claimant declines to confirm the electronic signature on the appointment of representative and does not properly complete any required attestation in accordance with existing policy on additional forms:

Do not enter the appointment into RASR

i. Return the notice of appointment (and any additional forms received) to the person who submitted them following existing policy in

GN 03910.040D.2

. Attach a manual notice using the following language:

“After subsequent contact with the claimant, we were unable to confirm the claimant’s intent to sign the attached form(s). We are returning the forms unprocessed and cannot recognize the appointment. We cannot disclose information or conduct business with the representative named on the notice until we are able to recognize the appointment.”

Enclose form(s) received with the notice of appointment.

ii. If the documents are in the electronic folder, move to the temporary green section/folder.

iii. Document the contact on an SSA-5002 ROC using the following language:

“Claimant’s electronic signature on notice of appointment and written form(s). Contacted and properly identified the claimant via telephone who rejected the signature(s) and denied intent to sign on MM-DD-YY.”

NOTE:

If you received additional forms, list these forms in the ROC and indicate that you also returned those forms to the representative unprocessed.

iv. Add the report to the red section of the electronic folder, or the paper folder for paper claims.

IMPORTANT: If the telephone call to the claimant leads you to suspect fraud is involved, complete a fraud/misconduct allegation in the Allegation Referral Intake System (ARIS). When completing the ARIS referral, select “Fraud Category” and report the behavior as “Appointed Representative Misconduct”.

If you are unable to reach the claimant on the first attempt:

i. Do not enter the appointment into RASR.

ii. Make three attempts on different days and different times to reach the claimant. If you leave a message for the claimant to return your call, be sure to leave an accessible return number. Do not include any sensitive or Personally Identifiable Information (PII) in your message. You may use the following script:

“This is [SSA employee name] from the Social Security Administration, calling for [claimant’s name]. Please have [claimant] return my call at [insert number].”

NOTE:

After the first unsuccessful attempt, send a call-in letter through DPS to the claimant and representative with your contact information requesting they contact you within 10 calendar days. Tickle the record for two weeks after the deadline listed in the notice.

iii. Document each contact attempt separately on the DW03 screen in MCS or Development Worksheet remarks in MSSICS using the following language:

“Claimant contacted to attest [cite forms]. Attempt to contact claimant via telephone on MM-DD-YY unsuccessful.”

iv. If two weeks elapse from the deadline listed on the letter and all attempts to reach the claimant are unsuccessful, return the notice of appointment and other relevant representational documents, and all other forms to the party who submitted them. Attach a manual notice using the following language:

“We were unable to reach the claimant to confirm their signature after multiple attempts. We have not processed these forms and cannot recognize the appointment. We cannot disclose information or conduct business with the representative named on the notice until we are able to recognize the appointment.”

v. Move any representational documents in the electronic folder to the temporary green section/folder.

vi. For non-iClaim situations, follow

GN 00204.012

to mail a closeout notice directly to the claimant for the protective filing created by the submitted benefit application.

NOTE

: If there is not an active MCS or MSSICS record, document the case using an MDW.

Claimant revokes the appointment of representative

If a claimant informs us that he or she wishes to revoke the appointment of a representative, but due to COVID-19, cannot mail or fax the written revocation, SSA-1696 SUP-1, or other written statement:

i. Stop conducting business with the revoked representative and do not disclose any claimant information;

ii. Document the contact with the claimant by completing either a ROC (Form SSA-5002), a Report of Contact (RPOC) entry in the Modernized Claims System, or a Report of Contact (DROC) in the Modernized SSI Claims System (MSSICS);

iii. Annotate the file and follow existing procedure in

GN 03910.060B.3.

to process the action and notifications; and

iv. Inform the claimant that he or she should submit the written statement or SSA-1696 SUP-1 when circumstances allow it.

NOTE:

Follow existing policy in

GN 03910.060

to obtain and process withdrawals of appointed representatives.

Appointed Representative submissions

a. Representative direct payment information

Appointed representatives with pending cases who have already submitted an

SSA-1696

or other writing, but never submitted the SSA-1695 to provide case-specific direct payment information, should file page 5 of Section 5 of the SSA-1696 with us. Generally, representatives can file this information via

Electronic Records Express

(ERE) or iAppeals portals, fax, eFax, mail, or in-person.

NOTE

: If a representative submits the (now obsolete) SSA-1695 instead, process it, following the procedure in

EM-12004 REV 5

. Do not also ask the representative to complete section 5 of the new SSA-1696.

During the COVID-19 pandemic

If a representative cannot submit the direct payment information using any of the methods described in subsection a. above and has no other means to submit it, you may follow existing communication instructions in GN 03360.005 to obtain affiliation/EIN information from the representative over the phone. In this situation, annotate the system with a ROC Form SSA-5002, or the ROC section in RASR to document information about the contact (e.g., reporter, date, time).

NOTE:

Representatives can only report their own affiliation information.

D. OHO Temporary OTR Attestation Process for Remote Telephone and Online Video Hearings

IMPORTANT: A claimant does not need to appoint relatives or friends who attend a hearing for general purposes unrelated to representation, such as providing general help or casual advice. (HALLEX I-1-1-1, GN 03910.001C.).

To expedite the hearing and decision-making process, the Administrative Law Judge (ALJ) will confirm that unless the relative or friend seeks to take on the role and responsibilities of the representative, the claimant does not need to submit an appointment for that relative or friend to offer support during the telephone hearing.

If the representative’s appointment is already recognized prior to the telephone or online video hearing

If the claim file contains a recognized appointment, the ALJ or appropriate OHO staff will verify the representative’s continued eligibility to represent claimants before us by checking the sanctions list at

https://www.ssa.gov/foia/resources/proactivedisclosure/OGC_SanctionedReps_List.pdf

, by visiting OHO’s website, or by searching RASR prior to the hearing. Once the ALJ confirms the parties are present at the hearing, there is no need to use the below attestation process, since we already have recognized the appointment.

2. Procedure for OTR attestations followed by a signed appointment – COVID-19 pandemic remote telephone and online video hearings only

Use this process when an attorney or non-attorney appears at a hearing by telephone or online video, and the claimant wants to appoint that person as his or her representative.

a. During the hearing

The ALJ will:

i. Assess whether the claimant understands basic information about the appointment (e.g., fee and responsibilities) and confirm that the claimant wishes to be represented by the representative who is appearing at the hearing via telephone or online video;

ii. Confirm that the claimant authorizes the agency to disclose his or her personal information to the representative during the hearing and the claimant’s intent to sign a written notice of appointment as soon as possible after the hearing;

iii. Ask the representative to submit a properly executed notice of appointment or the SSA-1696 as quickly as feasible; and

iv. Inform the claimant and the representative that he or she have entered their oral attestations into the record, but that issuance of a decision in the claim may be delayed pending receipt of a signed written notice of appointment document.

After the hearing

OHO staff will:

i. Take appropriate steps (e.g., contact the parties as appropriate) to ensure the timely submission of a valid and signed appointment of representative to avoid delays in issuing a decision;

ii. Ask the appointed representative to submit the written appointment documentation electronically, or by faxing or mailing it to the local field office and to inform OHO when the appointment is submitted (e.g., contact OHO staff to inform it was faxed);

iii. As needed, OHO will provide barcodes and fax numbers for WorkTrack;

iv. Notify the FO if a notice of appointment is received in the hearing office and forward it for processing following guidance in

HALLEX I-1-1-11 C

; and

v. Follow existing procedures in Standard Hearings Operating Procedure (SHOP) and

HALLEX I-2-1-10 C

to close the case if efforts to secure a valid notice of appointment or SSA-1696 fail.

E. Closing

Direct all program-related and technical 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 contact. OHO RO support staff may refer questions or unresolved issues to their Headquarters contacts in OCALJ.

F. References

GN 03316.125 Disclosure to Attorneys and Representatives
GN 03910.025 Authority of Appointed Representatives
GN 03910.040 Appointment of a Representative
GN 03913.025 Paper Registration (Form SSA-1699) – Individual
GN 03301.000 Disclosure and Confidentiality of Information
HA I-1-1-0 Representation of Claimants
HA I-2-6-0 Conduct of Hearings
EM 20029 Disaster Procedures – CDR Mailer Phone Process due to COVID-19 pandemic – One-Time Instructions
SI 00604.111 Signature: Item 63 and 65
GN 00204.055 Internet Claim (iClaim) Application
GN 00201.015 Alternative Signature Methods
GN 00204.001 Valid Application
GN 00204.010 Protective Filing
DI 10505.035 Documenting Employment Cases Using Forms SSA-821-BK (Work Activity Report- Employee) and SSA-823 (Report of SGA Determination – for SSA Use Only)
DI 81010.120 Using Form Attestation for Work Activity Reports
EM 21021 REV Online Form SSA-1696 Claimant’s Appointment of Representative
GN 00204.012E How to Close a Protective Writing

EM-20022 REV 3 - Temporary Instructions for the Bundled Receipt and Processing of an Electronically Signed SSA-1696 and Certain Other Forms - 11/12/2021

Emergency Message