Last Update: 4/11/2016 (Transmittal I-1-85)
HA 01120.095 Handling a Form
SSA-1695 for Direct Payment of Fees
Renumbered from HALLEX section I-1-2-95
The form SSA-1695, Identifying Information for Possible Direct
Payment of Authorized Fees, is now obsolete, and has been incorporated
into form SSA-1696. If the Office of Hearing Operations (OHO) or the
Office of Appellate Operations (OAO) receives a form SSA-1695 staff will
follow the below instructions as well as those contained in
EM-20004. OHO staff will follow the instructions in
SHOP section 1.3.5.1.
Form SSA-1695 was used by an appointed representative who is
eligible for and wants to receive payment of an authorized fee directly
from a claimant's past-due benefits. A representative may still submit
this form at the same time he or she submits a form SSA-1696,
Appointment of Representative, or an equivalent writing. For
more information about appointments, see Hearings, Appeals and
Litigation Law manual HA 01110.011.
An SSA-1695 contains personally identifiable information (PII)
about the representative, including the representative's Social Security
number (SSN), and is pertinent only for payment purposes. Therefore,
on receipt of an SSA-1695,
it is critical that staff or adjudicators in the OHO and OAO not associate
the form with a claim(s) file or exhibit the document.
Rather, when a representative submits an SSA-1695 to
an OHO or OAO office, staff will immediately redirect the form to
the field office (FO). The FO will use a black marker to mask the
representative's SSN completely and mark the form “processed.”
The FO will then associate the processed form with the claim(s) file. For
FO instructions, see EM-12004 REV 3.
OHO and OAO will not delay case adjudication
pending FO action. Because the form relates only to possible payment
issues, the processing of the form has no bearing on OHO or OAO's adjudication
of a claim(s).
If OHO or OAO staff discovers an unprocessed SSA-1695 in
a claim(s) file, OHO or OAO staff will immediately remove the document
from the claim(s) file and send the form to the FO for processing.
In a paper claim(s) file, OHO or OAO staff will “remove” the
form by simply removing it from the claim(s) file and sending the
form to the FO. However, if the claim(s) file is electronic, OHO or OAO
staff will “remove” the form by moving it to the C
section (Current Development/Temporary) of the claim(s) file. This
action will result in the permanent removal of the unprocessed form
at the time the case is closed.
There are unique circumstances involved if OHO or OAO mistakenly
exhibits an unprocessed SSA-1695.
For this situation, consult internal business processes or speak with a
supervisor.