Form SSA 1696Form SSA 1696Form SSA 1696
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COMPLETING THIS FORM TO APPOINT A REPRESENTATIVE
Choosing to be Represented
You can choose to have a representative help you when
you do business with Social Security. We will work with
your representative, just as we would with you. It is
important that you select a qualified person because, once
appointed, your representative may act for you in most
Social Security matters. We give more information, and
examples of what a representative may do, in the section
titled “Information for Claimants.”
Privacy Act Statement
Collection and Use of Personal Information
Sections 206(a) and 1631(d) of the Social Security Act, as
amended, authorize us to collect this information. We will
use the information you provide on this form to verify
your appointment of an individual as your representative
and his or her acceptance of the appointment.
Completion of this form is voluntary; however, if you
want to use this form to appoint someone to act on your
behalf in matters before the Social Security
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