TN 1 (07-10)

A. Introduction for appointed representatives using the SSA-1699

Individuals serving as appointed representatives complete and submit Form SSA-1699 (Registration for Appointed Representative Services and Direct Payment) to:

• Enroll for direct payment of fees, providing information we will reference whenever we receive a Form SSA-1696 (Appointment of Representative) and Form SSA-1695 (Identifying Information for Possible Direct Payments of Authorized Fees) related to a particular case, or

• Update their registration information when it has changed, or

• Initiate access to electronic services per GN 03913.020.

Representatives who previously registered for direct payment using the registration process in place prior to October 31, 2009, must complete a new paper Form SSA-1699 in its entirety to:

• Revise their address, affiliation, or payment (by check or direct deposit) information, or

• Provide additional information required to initiate access to certain electronic services (see GN 03913.020).

B. Procedure for completing and submitting the SSA-1699

We use Form SSA-1699 to:

• Collect a representative’s personal information, including his or her home mailing address,

• Request an attorney representative’s standing and information needed to verify his or her bar or court membership,

• Specify mailing addresses other than the home address for receiving notices and Form 1099-MISC,

• Identify the representative’s preferred payment method: by direct deposit or paper check,

• Indicate employment affiliation with firms or organizations, and

• Obtain required attestations and a signature under penalty of perjury.

Representatives may print a blank Form SSA-1699 for completion, or they may fill in the PDF form online from a link on our website at http://www.socialsecurity.gov/ar/ , prior to printing it. We recommend that the representatives fill in the PDF form online for legibility.

Representatives register and update their registration information by faxing Form SSA-1699, to the Office of Earnings Operations (OEO) in the Office of Central Operations (OCO) at 1-877-268-3827. Field offices and representatives should fax the forms, one form at a time, to this dedicated fax number. The field office shreds the SSA-1699, after successfully faxing the form to OEO.

NOTE: OEO does not input any forms related to appointed representatives other than Form SSA-1699, nor does OEO handle correspondence from representatives.

Click here to obtain the most current Form SSA-1699 in PDF format. Members of the public may complete and print the SSA-1699 from a link on our website: http://www.socialsecurity.gov/ar/ .