GN 03910.040: Appointment and Revocation of Appointment of Representative

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~~Effective Dates: 08/23/2016 - Present~~
Effective Dates: 08/16/2018 - Present
TN 8 (12-06)
GN 03910.040 Appointment and Revocation of Appointment of Representative
A. Policy
A claimant's appointment, or revocation of an appointment, of a person as his or her representative must be in writing, and must be filed with SSA.
A parent of a claimant under age 18 may appoint a representative or revoke an appointment for the claimant, except when SSA has determined that the claimant will be his or her own payee. If SSA has determined that a claimant under age 18 will be his or her own payee (see GN 00502.070), the claimant may appoint and revoke his or her representative. A representative payee may not appoint or revoke the appointment of a claimant’s representative; however, a legal guardian may do so for a legally incompetent claimant. Guardians appointed by a court for the duration of the legal proceedings, also known as “guardians ad litem,” are legal guardians for the purposes of this section and can appoint a representative, or revoke an appointment.
Correctly documenting the claim file and SSA's records regarding representative involvement is essential. It ensures that SSA will, as required:
* contact the claimant through, or with the permission of, the appointed representative;
* provide the representative a copy of all notices;
* authorize any fee before a representative can charge or collect it; and
* withhold Title II and/or Title XVI past-due benefits for direct payment of part or all of an authorized fee directly to a representative who is eligible for direct fee payment. (See GN 03920.017 – Payment of Representative’s Fee.)
Documenting a revocation of appointment or a representative's withdrawal from a case is equally important, to ensure that SSA does not incorrectly disclose information to a former representative, or incorrectly withhold benefits based on an appointment that is no longer in effect.
When you receive appointment documentation (Form SSA-1696 or equivalent writing) from a representative, you must send the representative an acknowledgement of appointment receipt (SSA-L1697-U3), see GN 03910.090 Exhibit 3. In addition you must acknowledge receipt of any material not directly related to the appointment of the representative. Such materials includes: any appeals requests forms, such as, SSA-561 (Request for Reconsideration) see GN 03102.225, SSA-61 (Request for Review by a Federal Reviewing Official) see AM-06173, HA-501 (Request for Hearing by Administrative Law Judge), see GN 03103.020, HA-520 (Request for Review of Hearing), see GN 03104.200 or equivalent). To acknowledge receipt of Form SSA-1696 or equivalent writing and any material not directly related to the appointment, date stamp, copy, and return all material along with the acknowledgement of appointment receipt notice (SSA-L1697-U3) to the representative with a copy to the claimant.
B. Policy - Notice of appointment and supplemental appointment
1. General
The regulations provide that to appoint a representative, the claimant must:
* sign a written notice appointing the person to be his or her representative in dealings with SSA and
* file the notice with SSA.
Form SSA-1696-U4 (see GN 03910.090, Exhibit 2) or other equivalent written statement constitutes proof of appointment.
The regulations further provide that if the claimant appoints as the representative a non-attorney, the non-attorney must sign the notice of appointment. Although it is not required that attorneys sign the notice, SSA strongly encourages the practice; by signing the notice of appointment representatives certify that they meet certain qualifications and will abide by the Act and regulations concerning fees. In addition, all representatives, including attorneys, are required to sign Part III (Fee Arrangement) of the SSA-1696 only if they are selecting one of the waivers. Refer to GN 03920.020 for more information on waivers.
Either an attorney or non-attorney may use a rubber stamp or e-signature to sign the notice. SSA will accept a rubber-stamped or an electronic signature unless there is a reason to doubt that it represents the intent of the representative to accept the appointment.
A notice of appointment may be combined with or included in another document, such as a contract or fee agreement. In such cases, if the representative or claimant wishes to retain the original signed copy of the document, SSA will accept a photocopy or facsimile of the original signed combined document.
SSA also accepts a photocopy or facsimile of an original signed notice of appointment when it is not included with another document. However, in either situation, the original document or notice of appointment retained by either party must contain the claimant’s signature in ink.
2. Date a claimant signs the notice of appointment of a representative
SSA considers the date the claimant signed the notice of appointment of a representative (i.e. the date shown on the document) as the signature date. This is not necessarily the date that SSA receives the document. However, if the claimant did not record the date on the document, SSA uses the date SSA receives the notice of appointment as the signature date.
3. Supplemental appointments
A supplemental appointment (SSA-1696-U4) may be submitted by a representative when the information provided on the supplemental appointment does not affect the claimant/representative's appointment relationship. Under certain circumstances, the supplemental appointment may require the signature of the claimant
For example if the representative and the claimant signed and submitted an appointment of representative on Form SSA-1696-U4 (or equivalent written statement) on or after February 28, 2005, but before the date the representative became eligible for direct fee payment, representatives are required to submit a supplemental SSA-1696-U4, for each case in which the representative wished to receive direct payment. The supplemental appointment is used to advise SSA of the change in the representative's direct payment eligibility status. Supplemental appointments in these situations do not have to be signed by the claimant.
If the appointment was entered into before February 28, 2005, both the claimant and representative must sign the supplemental appointment. See GN 03920.018.B.4.
4. Firm or organization named as representative
Although SSA does not recognize firms or entities as representatives, claimants sometimes complete notices of appointment that appear to be appointments of a law firm or other entity. In such cases, if an individual in the firm signs the notice accepting the appointment, SSA will recognize that individual, not the firm, as the claimant's representative. For relevant policy on fee agreements, see GN 03940.003A.2.
Although SSA does not recognize firms or entities as representatives, claimants sometimes complete notices of appointment that appear to be appointments of a law firm or other entity. In such cases, if an individual in the firm signs the notice accepting the appointment, SSA will recognize that individual, not the firm, as the claimant's representative. For relevant policy on fee agreements, see GN 03940.003B.2.
EXAMPLE: A claimant submits a Form SSA-1696-U4, completed in Section I to show “Hawthorne and James, a Professional Corporation” as the claimant's representative. The form is signed in Section II by “Henry James,” accepting the appointment. In this case, SSA will recognize Henry James as the claimant's representative.
C. Policy - Revocation or withdrawal
A claimant may revoke the appointment of a representative at any time. A revocation of appointment must be in writing and must be signed by the claimant. SSA does not have a standard form for revoking the appointment of a representative. Therefore, SSA must ensure that the representative whose appointment has been revoked is properly advised, either by obtaining the representative's signature on the revocation, or by sending the representative a copy of the statement of revocation signed by the claimant. SSA will include a copy of any written notice of revocation in the claim file.
A representative may withdraw from representing the claimant at any time by notifying the claimant and SSA. The withdrawal must be in writing and signed by the representative. SSA will include a copy of any written notice of withdrawal in the claim file.
D. Policy - Multiple representatives appointed concurrently
A claimant may appoint more than one person to serve as his or her representatives concurrently. The claimant must appoint each co-representative individually, in writing, and specify who the principal representative is. Each co-representative must meet the qualifications in GN 03910.020B.1. or GN 03910.020B.2. SSA must secure a separate SSA-1695 from each co-representative who is eligible to receive, and who is or will be requesting direct payment, even when all co-representatives are members of the same firm.
SSA will make contacts with, and send notices or requests for development to, only the principal representative. The principal representative will provide copies of notices or requests to other co-representatives.
E. Policy - Multiple representatives appointed successively
A claimant may revoke the appointment of one representative and appoint another person to represent him/her. In such cases, the claimant must submit:
* a signed statement revoking the appointment of the former representative; and
* a notice of appointment of the new representative.
F. Policy - Documenting the system
1. All representatives
The Act provides that SSA will maintain a current record of the identity of the person representing the claimant in the electronic information retrieval system. Therefore, SSA personnel who are involved in documenting a claimant's appointment, revocation of appointment, or withdrawal of a representative at any level of claim adjudication will annotate the appropriate systems according to the instructions in GN 03910.040H. through GN 03910.040J.
2. Representative is an attorney or an Eligible for Direct Fee Payment Non-Attorney (EDPNA)
Internal Revenue Service regulations require SSA to issue an Internal Revenue Service Form 1099-MISC (Social Security Benefit Statement) to each representative paid $600 or more in fees during a calendar year. To comply with this requirement, if the claimant signs the notice of appointment beginning January 1, 2007 or after, SSA will pay a fee directly to the claimant’s representative only if the representative registers with SSA before SSA effectuates a favorable decision that results in past-due benefits. Through this registration requirement process, the representative provides the information SSA requires to pay the fee and to issue the Form 1099-MISC to the representative.
There are two steps to the registration requirement process:
a. Step 1
The representative submits a Form SSA-1699 (Registration for Appointed Representative Services and Direct Payment), see GN 03910.090 Exhibit 7, and/or Form SSA-1694 (Request for Business Entity Taxpayer Identification), see GN 03910.090 Exhibit 5. Form SSA-1694 can be submitted online or to an SSA office. The representative must submit Form SSA-1699 via fax, following procedure in GN 03913.000. SSA stores the information the representative provides on these forms on the Appointed Representative Database (ARDB). The information on the ARDB is revised only when the representative submits a new Form SSA-1699 and/or SSA-1694. Accordingly, a representative is responsible for notifying SSA when the information he/she previously provided changes. (See GN 03910.042 – Representative and Employer Registration.)
b. Step 2
The representative submits a paper Form SSA-1695 (Identifying Information for Possible Direct Payment of Authorized Fees), see GN 03910.090 Exhibit 6 prior to the effectuation of the claim, along with a paper Form SSA-1696-U4 to the appropriate FO. When SSA inputs the information the representative provides at step 2 of the requirement process (i.e., submits Form SSA-1695) a link is established on the ARDB between the claimant and the representative. The representative’s information on the ARDB then propagates to and updates the representative’s information on the claimant’s Title II and/or Title XVI claims records.
G. Policy - Written inquiry on behalf of claimant outside U.S.
If SSA receives a written inquiry from an official of a foreign consulate or embassy on behalf of a claimant outside the U.S., SSA will consider the official authorized to act as the claimant's representative without a formal appointment. SSA will include the official's inquiry in the claim file in place of a notice of appointment of representative.
H. Procedure - FO action - Claim file in FO
The FO will take the actions described below in numbers 1 through 9 (number 6 if a Form SSA-1695 is submitted) if:
* the claimant appoints or revokes the appointment of a representative, or the representative withdraws, as applicable; and
* the claim is at the initial, reconsideration, Federal reviewing official, or hearing level; and
* the FO has not yet sent the claimant's appeal request to the Office of Disability Adjudication and Review (ODAR),
1. Obtain notice of appointment
In appointments, ensure that the claim file contains a signed SSA-1696-U4 or other written notice of appointment. Distribute and file the copies of the SSA-1696-U4.
In concurrent claims, if there are paper claims folders, file the original in the Title II claim file and a copy in the Title XVI claim file.
Contact the claimant and request a notice of appointment when there is indication that the claimant has engaged a representative, but the claim file does not contain a notice of appointment. Request that both the claimant and the representative sign the notice. Send the claimant an SSA-1696-U4 for this purpose.
2. Representative Does Not Sign Notice
Accept a notice of appointment of an attorney representative signed only by the claimant, if submitted (e.g., an SSA-1696-U4 completed in Section I with the name of an attorney and signed by the claimant, but not signed in Section II by the attorney, accepting the appointment). Do not return the notice for the attorney's signature.
Do not accept a notice of appointment of a non-attorney representative that is not signed by the representative. Return the notice to the appointed representative for his or her signature, as required by the regulations.
3. Firm or organization named as representative
Accept an appointment of representative that names a firm or organization as representative (e.g., an SSA 1696-U4 with the name of a firm entered in Section I) if the notice of appointment is signed by one or more individuals in the firm accepting the appointment.
Do not accept the appointment if a firm is named as representative in the notice, but no individual signed accepting the appointment. Return the notice to the firm and explain SSA's policy that the appointed representative must be a specific individual or individuals.
4. Multiple representatives
If the claimant submits a notice of appointment, but has previously appointed another person as representative, and there is no indication that the previously appointed representative's authority has expired under the criteria in GN 03910.060A, contact the claimant and determine whether:
* both representatives are to serve as co-representatives; or
* the claimant intended to revoke the previous appointment; or
* the previously appointed representative withdrew.
If the representatives will serve as co-representatives, ensure that the file is documented to show the principal representative. The SSA-1696-U4 has a fill-in to designate the principal representative.
If the claimant intended to revoke the previous appointment, obtain a signed statement of revocation from the claimant. If the previously appointed representative withdrew, obtain a copy of any written statement to that effect from the representative, or document the file with a report of contact if the representative did not submit a written statement.
5. Acknowledge notice of appointment
Send Form SSA-L1697-U3 (Notice to Representative of Claimant Before the Social Security Administration) to the appointed representative, and send a copy to the claimant. See GN 03910.090 Exhibit 3. *When the claimant is appointing several representatives, you may receive one notice of appointment with multiple names on it. Unless other reasons invalidate it, do not request separate notices for each representative, accept the notice but recognize each individual separately via an SSA-L1697-U3.
IMPORTANT: Sending a copy of the acknowledgment alerts the claimant to the fact that SSA recognized the appointment and ensures the claimant's continued concurrence with it.
6. Acknowledge SSA-1695
After successfully processing Form SSA- 1695, Identifying Information for Possible Direct Payment of Authorized Fees, send the acknowledgement notice to the appointed representative. The notice is available in GN 03910.090, Exhibit 9.” This notice must be sent.
7. Flag the claim file
Activate the Representative flag for an electronic folder, or affix Form SSA-1128 (Representative Involved) to the front lower right corner of the paper claim folder. See GN 03910.090, Exhibit 4 for the Form SSA-1128. If affixing Form SSA-1128, indicate:
* whether the representative is an attorney, a non-attorney participating in the direct payment project, or a non-attorney not participating in the direct payment project;
* if the representative is an attorney or a non-attorney participating in the direct payment project, whether the representative is registered for direct fee payment and if the representative was appointed before January 1, 2007.
* when a fee agreement is involved (see GN 03940.000);
* whether a fee agreement is approved or disapproved;
* when the representative waives a fee;
* when an attorney or an EDPNA waives only direct payment of the fee from withheld past-due benefits;
* whether the claim is Title II, Title XVI or concurrent;
* when a third party has paid or will pay a representative's fee (see GN 03920.005B. and GN 03920.010B.)
* If the representative submits a fee agreement, but you are not the decision maker (see GN 03940.002), check the block on the SSA-1128 labeled “Fee Agreement in File,” but do not check either the “Approved” or “Disapproved” block.
If a representative enters the case before you send the medical file to the disability determination service (DDS) or ODAR, activate the Representative flag for an electronic folder or attach a completed SSA-1128 to the paper medical file in disability claims.
Remove the Representative flag from the electronic folder or the Form SSA-1128 from the paper claim file if the claimant revokes an appointment of representative, or the representative withdraws from the case, and the claimant does not appoint another representative.
8. Annotate the system
a. Representative is not on the ARDB or a link to representative cannot be established
When the representative is a non-attorney; or an attorney or EDPNA who is not on the ARDB, or when you cannot establish a link between the claimant and the representative on the ARDB, annotate the system with the representative's name, address, and phone number (in multiple representative situations, enter the principal representative's name, address, and phone number) and, if applicable, information about:
* a fee agreement;
* waiver of a fee; or
* waiver of direct payment.
Delete the data identifying the representative from the system if you are annotating a revocation or a withdrawal. Do not delete data regarding the representative unless there is written documentation of a revocation or withdrawal in the claim file.
In pending claims, annotate the:
* DW01 issue of “1696,” per MSOM MCS 008.004); and the
* EDCS transfer screen to that effect. See DI 31001.001 and DI 81010.085.
* NOT2 screen in a Title II MCS claim per MSOM MCS 009.009), and the Special Message field of the MBR (after MBR is established) in a Title II non-MCS claim per MSOM T2PE 007.008); and the
* SSR via the Authorized Representative (UATH) screen in a Title XVI claim per MSOM BUSSR 002.013).
In reconsideration requests and hearing requests on MCS, annotate system per MSOM MCS 010.004) or HNG2 (MSOM MCS 010.006) screen, as applicable.
* In PE situations, query the system per MSOM QUERIES 006.002, MSOM QUERIES 006.022, and MSOM QUERIES 006.023), which accesses representative identification information gathered from the MBR, the SSR, and the Authorized Representative File on the Modernized Data Input (MDI) system.
NOTE: Prior to November 18, 2006, these procedures applied to all Title II and Title XVI claims with appointed representatives. On November 18, 2006, the Office of Systems will implement the systems changes necessary to permit representatives to complete the 2-step representative registration process described in GN 03910.042. However, the Title XVI claims will not have the linkage until a future date.
9. Label evidence
Label any evidence submitted by a representative without a cover letter or other identifier by annotating the evidence in the upper right corner “Submitted by [Representative's Name] on [Date].”
I. Procedure - FO action - Claim file not in FO
When the claim file is not in the FO because, e.g., the FO has sent the claim file to the PC or to ODAR; and the FO receives a notice of appointment of representative or other material regarding representation of a claimant, take the following actions:
1. Acknowledge notice of appointment
Send the appointed representative Form SSA-L1697-U3 (Notice of Representative of Claimant Before the Social Security Administration) See GN 03910.090 Exhibit 3.
2. Flag the material
Activate the electronic Representative flag for an electronic file. If forwarding paper documents to another office, complete an SSA-1128 (see GN 03910.040H.6.) to the extent possible based on the information in the material submitted.
3. Annotate the system
In Title II MCS claims, review the DW01 and NOT2 screens. In Title II non-MCS claims, Title XVI claims, and PE situations under both Titles II and XVI, obtain a QRID query (see MSOM QUERIES 006.002, MSOM QUERIES 006.022, and MSOM QUERIES 006.023).
Follow the procedures in GN 03910.040H.7. to enter or update the information regarding the representative's name, address, phone number. Enter information about a fee agreement, waiver of a fee, or waiver of direct payment into the appropriate system component(s), as necessary, based on the material received (see GN 03910.040H.7.).
Also annotate the system according to this instruction if ODAR (i.e., a Federal reviewing official, a hearing office (HO) or the Appeals Council) notifies the FO that ODAR received an appointment of representative.
“If you are annotating a revocation or a withdrawal based on written documentation in the material you received, delete the data identifying the representative from the system. Annotate EDCS and notify the office where the file is located of the changes. See DI 81010.095.
4. Label evidence
Label any evidence submitted by a representative without a cover letter or other identifier by annotating the evidence in the upper right corner “Submitted by [Representative's Name] on [Date].”
5. Update the claim file and route the material
Update the claim file with the appointment and any other material. If it is a paper claim file, send the appointment, any other material and a completed SSA-1128 to the component in which the claim file is currently located. If a disability claim is pending and you are forwarding paper medical evidence to the DDS, attach the SSA-1128 to the front page of the medical evidence.
J. Procedure - PC action - Pending claim
When a claim is in the process of effectuation or adjudication in the PC; and material regarding representation that has not previously been associated with the claim file is received in the PC, take the following actions:
1. Notice of appointment from FO or ODAR
If the material includes a notice of appointment and it was received from an FO or ODAR, assume that the FO or ODAR acknowledged the appointment. Affix the SSA-1128 prepared by the FO or ODAR to a paper claim file. Activate the Representative flag in an electronic file if the FO did not.
2. Notice of appointment from claimant or representative
If the claimant or representative submits the material directly, and it includes a notice of appointment, acknowledge the receipt of the appointment document by sending SSA-L1697-U3 to the appointed representative, with a copy to the claimant. The acknowledgment notice is available in the Document Processing System (DPS) and AURORA. (See GN 03910.040H.5.)
Add the Representative flag to an electronic file or complete an SSA-1128 (see GN 03910.040H.6.) and affix the form to the front lower right corner of a paper claim file.
3. No notice of appointment in claim file
If the claim file indicates, or an FO sends material that indicates the involvement of a representative in the case (e.g., additional evidence accompanied by a cover letter from an attorney), but a written notice of appointment is not in the claim file, contact the FO to determine whether the notice of appointment was retained there. If so, ask the FO to send a copy of the appointment. If not, obtain a copy of the appointment from the claimant, the representative or, if necessary, through the FO (see MSOM ADMIN 004.002).
If an HO sends material that indicates involvement of a representative, but a written notice of appointment is not in the claim file, contact the HO to obtain a copy of the notice of appointment.
4. Annotate the system
In Title II MCS claims, review the NOT2 screen. In Title II non-MCS claims, obtain a QRID query (see MSOM QUERIES 006.002 and MSOM QUERIES 006.022). Enter or update the information regarding the representative's name, address, phone number, and, if applicable, fee agreement, waiver of a fee, or waiver of direct payment into the appropriate system component(s), as necessary. Follow the procedures in GN 03910.040H.7. to annotate the system.
If you are annotating a revocation or a withdrawal based on written documentation in the material you received, delete the data identifying the representative from the system.
K. Procedure - PC action - PE situations
Take the action(s) in GN 03910.040J. if:
* the PC has completed effectuation or adjudication of a claim, including the claims of any auxiliary beneficiaries;
* material regarding representation that has not previously been associated when the claim file is received in the PC; and
* the appeals period for the last determination effectuated in the claim has not expired.
If the material includes a notice of appointment, see GN 03910.040J.1, GN 03910.040J.2., and GN 03910.040J.4. If there is no notice of appointment in the claim file, see GN 03910.040J.3. and GN 03910.040J.4. Send to the newly appointed representative copies of any notice of determination that the PC sent the claimant.

POMS Reference

GN 03910.040: Appointment and Revocation of Appointment of Representative