TN 22 (11-25)

GN 03905.030 Forms SSA-1696 Appointment, Revocation, and Withdrawal

A. When to use

A claimant must notify us in writing if he or she appoints an individual to represent him or her in dealings with us. Claimants must use our standard Form SSA-1696 (Claimant’s Appointment of a Representative) for the appointment.

A claimant must also let us know in a signed and dated writing when he or she wants to revoke a representative's appointment. The writing must indicate the name of the representative whose appointment the claimant is revoking. Claimants may, but are not required to use our standard Form SSA-1696-SUP1 (Claimant's Revocation of the Appointment of a Representative) to revoke the appointment of a representative.

Likewise, an appointed representative must notify us in a signed and dated writing when he or she wants to withdraw from an appointment. Representatives may, but are not required to use our standard Form SSA-1696-SUP2 (Representative's Withdrawal of Acceptance of Appointment) to withdraw acceptance of an appointment.

For more information on appointing a representative and completion of standard Form SSA-1696, see GN 03910.040 Appointment of a Representative.

For more information on revoking or withdrawing from representation, and completion of standard Forms SSA-1696-SUP1 and SSA-1696-SUP2, see GN 03910.060 Termination of a Representative's Appointment.

B. Exhibits

1. Form SSA-1696 Claimant's Appointment of a Representative

See Form SSA-1696 to obtain the most current PDF.

2. Form SSA-1696-SUP1 Claimant's Revocation of the Appointment of a Representative

See Form SSA-1696-SUP1 to obtain the most current PDF.

3. Form SSA-1696-SUP2 Representative's Withdrawal of Acceptance of an Appointment

See Form SSA-1969-SUP2 to obtain the most current PDF.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203905030
GN 03905.030 - Forms SSA-1696 Appointment, Revocation, and Withdrawal - 11/18/2025
Batch run: 11/18/2025
Rev:11/18/2025