Complete your Form SSA-1696

This service allows you and the individual you agree to represent (i.e., the claimant) to complete your respective sections of the notice of appointment (Form SSA-1696) online, sign the form electronically, and submit it to us electronically. Before you begin, you will need the following information:

Your valid email address.
The claimant's valid email address.
Your current mailing address and phone number.
If you are registered, you will also need your Representative Identification (RepID) (This is the number you were assigned when you registered with us).

IMPORTANT: Submission of this form is a two-step process for each signer. We will not receive or process the form until both parties have completed their steps.

Step One. You, the Representative, must complete your designated sections of the form, sign the form electronically, and submit it to Adobe Sign.

Before beginning the form, you will first enter your and the claimant’s email addresses into the application online.
You will also create a password that will be required for you and the claimant to access the form. You should provide the password to claimant by phone, in person, or SMS text message (standard message and data rates may apply). If you are unable to contact the claimant by phone, in person, or by text, then you may send the password via a separate email message.
You will receive an email from adobesign@adobesign.com containing a link and instructions on how to access the form.
NOTE: After you sign the form, the claimant will also receive an email from adobesign@adobesign.com containing a link and instructions on how to complete his or her portions of the form and submit it to SSA.
The form will be available to you and the claimant for 15 calendar days after you initiate the process online (i.e., when you enter your and the claimant’s email addresses in order to receive a link to complete the form). You should inform the claimant about the importance of taking action in response to this email upon receipt of the email. If you and the claimant do not complete, sign, and submit the form within fifteen (15) calendar days, you will need to start a new form.

Step Two. Upon receipt of email notification that the first step has been completed by you, the claimant accesses and reviews the partially completed form, completes their designated sections, signs the form electronically, and submits the form to us.

We will notify you and the claimant by mail when your form has been processed.

PLEASE NOTE:

This website is most compatible with the following browsers: Microsoft Edge and Google Chrome.
After 60 minutes of inactivity, the system will end your session, the form will delete the information you entered during the session, and you will have to repeat the first step again.
If you (or the claimant) do not see an email notification within a few minutes of submission, check your junk folder. If you do not receive an email, you will need to submit a new form. We recommend that you verify the accuracy of your and your claimants' email address.
A daily email reminder will be sent to you and the claimant until the form has been submitted or until the time expires.
If you or the claimant lose the password, we do not have the ability to reset the password. You will have to restart the process.

Sections 206 and 1631(d) of the Social Security Act, as amended, allow us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent us from appointing a representative to act on your behalf.

We will use the information to verify the appointment of your representative and his or her acceptance of the appointment. We may also share your information for the following purposes, called routine uses:

To a congressional office in response to an inquiry from that office made on behalf of, and at the request of, the subject of the record or a third party acting on the subject’s behalf;
To Federal, State, and local law enforcement agencies and private security contractors, as appropriate, information necessary:
1. to enable them to protect the safety of Social Security Administration (SSA) employees and customers, the security of the SSA workplace, and the operation of SSA facilities; or
2. to assist investigations or prosecutions with respect to activities that affect such safety and security or activities that disrupt the operation of SSA facilities; and
To contractors and other Federal agencies, as necessary, for the purpose of assisting SSA in the efficient administration of its programs.

In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs. A list of additional routine uses is available in our Privacy Act System of Records Notices (SORN) 60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on October 31, 2019, at 84 FR 58422; 60-0320, entitled Electronic Disability Claim File, as published in the FR on June 4, 2020, at 85 FR 34477; and 60-0325, entitled Appointed Representative File, as published in the FR on October 8, 2009, at 74 FR 51940. Additional information and a full listing of all our SORNs, is available on our website at http://www.ssa.gov/privacy.