TN 21 (12-24)

GN 03905.035 Registration, Appointment, and Services for Representatives (RASR) Appointment, Revocation, and Withdrawal Notices

A. When to use

The claimant or the representative must submit a completed, current Form SSA-1696 (Claimant's Appointmen of a Representative) to appoint a representative . When we process Form SSA-1696 in RASR, the system automatically the sends appointed representatives and their claimants relevant notices. This section contains the notices related to appointment, withdrawal, and revocation of a representative.

B. Exhibits

1. RSR103 - Appointment confirmation to appointed representative (without assignment)

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.

2. RSR104 - Appointment confirmation to claimant

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.

3. RSR106 - Appointment revocation to appointed representative

[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, visit www.ssa.gov/representation/.

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.

4. RSR107 - Appointment withdrawal to claimant

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.

5. RSR108 - Appointment withdrawal to claimant - replacement principal

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.

6. RSR119 - Appointment Confirmation to Representative with Assignment

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.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203905035
GN 03905.035 - Registration, Appointment, and Services for Representatives (RASR) Appointment, Revocation, and Withdrawal Notices - 12/16/2024
Batch run: 12/16/2024
Rev:12/16/2024