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:
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 firstname.lastname@example.org 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 email@example.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 5 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 five (5) 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.
After successful submission of the form, firstname.lastname@example.org will send an email to you and the claimant with a link to the submitted form. This will allow you to save a copy for your records.We will notify you and the claimant by mail when your form has been processed.
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:
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.