---
title: SSA-1696 Customer-Assembly Preparation Kit
description: Prepare SSA-1696 online and receive an unsigned printed kit for your own final review, hand-signing, assembly, and submission.
seotitle: SSA-1696 Customer-Assembly Preparation Kit
seo-description: Prepare SSA-1696 online and receive an unsigned printed kit for your own final review, hand-signing, assembly, and submission.
group: resources
indexable: true
llms: false
schema: webpage
og-image: /forms/ssa-1696/thumbnail
og-image-alt: SSA-1696 — Appointment of Representative (Social Security) generated form preview
published: 2026-07-12
updated: 2026-07-12
tags:
  - social security
  - ssa
  - representation
  - appeals
  - disability
path: /forms/ssa-1696
---
# SSA-1696 Customer-Assembly Preparation Kit

Prepare SSA-1696 online and receive an unsigned printed kit for your own final review, hand-signing, assembly, and submission.

## How it works
1. **Answer the guided questions and review the prepared form information.** - 
2. **PostalForm prints the official form with signature areas left blank and sends the customer-assembly kit only to your verified address.** - 
3. **After delivery, follow the cover instructions, hand-sign where required, and add every original, certified record, payment, witness, certification, companion form, or other physical item.** - 
4. **Verify the current deadline and destination, then personally complete final submission through the official channel.** -


## Form summary
This workflow helps you prepare an SSA-1696 appointment-of-representative form for both parties to complete. PostalForm prepares the official form and delivers the unsigned preparation kit only to your verified address. PostalForm does not file, serve, or submit it. Have the claimant and representative review the form, apply compliant signatures and dates, complete any representative registration or fee steps, and submit it to the SSA office handling the pending claim or appeal.

## What you need
- Your Social Security number (and the number holder’s if you claim on someone else’s record)
- Your representative’s name and SSA Rep ID (they must be registered with SSA)
- The claim types the appointment covers
- The fee arrangement your representative selected
- Signatures from both you and your representative
- The address of the Social Security office handling your claim (from your SSA letters or ssa.gov/locator)
- Hand-sign the printed form after the preparation kit is delivered

## Data collected
- Your name and Social Security number (and the number holder’s, if your claim is on someone else’s record)
- Your representative’s name and SSA Rep ID
- The claim types the appointment covers
- Family members covered by the appointment; representative certifications, fee selections, initials, and both signatures and dates remain blank

## Where it gets mailed
PostalForm mails the unsigned preparation kit only to the customer or authorized signer at the verified delivery address entered during checkout.

Final submission: Have the claimant and representative review the form, apply compliant signatures and dates, complete any representative registration or fee steps, and submit it to the SSA office handling the pending claim or appeal.

## Packet order
- Customer assembly instruction cover (remove and keep before final submission)
- Prepared unsigned form (signature and reserved third-party fields blank)

## Common mistakes
- Appointing a representative who has not registered with SSA — since September 30, 2024, SSA requires a Rep ID before recognizing a new appointment.
- Mailing the form with only one signature — a new appointment needs both yours and your representative’s.
- Leaving the fee arrangement blank — if the representative is eligible for direct payment, SSA assumes they will seek it.
- Sending the form to SSA headquarters or the State Disability Determination Services office instead of the office handling your claim.
- Using one form for several representatives — SSA requires a separate SSA-1696 for each.
- Filing the form when there is no pending claim or issue — SSA rejects an SSA-1696 with nothing to attach it to.

## Agent summary
Customer-assembly workflow for SSA-1696. It prepares the form and sends an unsigned kit only to the customer. It must never be represented as direct filing, service, or agency submission. Final customer action: Have the claimant and representative review the form, apply compliant signatures and dates, complete any representative registration or fee steps, and submit it to the SSA office handling the pending claim or appeal.

## For assistants
This is a human-only customer-assembly workflow and is not available for automated or machine ordering.

- PostalForm delivers an unsigned preparation kit only to the customer or authorized signer.
- The customer must remove and keep the PostalForm cover, complete every physical signature, enclosure, certification, and final-submission step, and verify the current deadline and destination.

## LLM field schema
```json
[
  {
    "id": "submission_reason_new",
    "label": "Appoint a new representative (most common)",
    "type": "checkbox",
    "required": true,
    "meta_class": "radio",
    "ui_width": null,
    "group_id": "submission-reason",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "submission_reason_update",
    "label": "Update information from a form you already sent",
    "type": "checkbox",
    "required": false,
    "meta_class": "radio",
    "ui_width": null,
    "group_id": "submission-reason",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "update_section_principal_rep",
    "label": "Who my principal representative is (Section 3)",
    "type": "checkbox",
    "required": true,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "submission-reason",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "submission_reason_update",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "update_section_claim_type",
    "label": "The claim types my representative handles (Section 4)",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "submission-reason",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "submission_reason_update",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "update_section_rep_status",
    "label": "My representative's status, disqualifications, or suspensions (Section 5A)",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "submission-reason",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "submission_reason_update",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "update_section_rep_affiliation",
    "label": "My representative's firm or organization details (Section 5B)",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "submission-reason",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "submission_reason_update",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "update_section_assignment",
    "label": "Direct payment of the fee to a firm — assignment (Section 5C)",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "submission-reason",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "submission_reason_update",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "update_section_fee_arrangement",
    "label": "The fee arrangement (Section 6)",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "submission-reason",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "submission_reason_update",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "update_section_other_claimants",
    "label": "Family members covered by the appointment (Section 7)",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "submission-reason",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "submission_reason_update",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "claimant_first_name",
    "label": "Your first name",
    "type": "text",
    "required": true,
    "meta_class": "name",
    "ui_width": null,
    "group_id": "claimant-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claimant_initial",
    "label": "Your middle initial",
    "type": "text",
    "required": false,
    "meta_class": null,
    "ui_width": "quarter",
    "group_id": "claimant-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claimant_last_name",
    "label": "Your last name",
    "type": "text",
    "required": true,
    "meta_class": "name",
    "ui_width": null,
    "group_id": "claimant-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claimant_ssn_first3",
    "label": "Your Social Security number — first 3 digits",
    "type": "text",
    "required": true,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "claimant-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claimant_ssn_mid2",
    "label": "Middle 2 digits",
    "type": "text",
    "required": true,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "claimant-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claimant_ssn_last4",
    "label": "Last 4 digits",
    "type": "text",
    "required": true,
    "meta_class": "ssn_last4",
    "ui_width": "third",
    "group_id": "claimant-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "has_number_holder",
    "label": "Is your claim based on someone else's work record (for example, a spouse or parent)?",
    "type": "checkbox",
    "required": true,
    "meta_class": "yes_no",
    "ui_width": null,
    "group_id": "claimant-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "number_holder_first_name",
    "label": "Number holder's first name",
    "type": "text",
    "required": true,
    "meta_class": "name",
    "ui_width": null,
    "group_id": "number-holder",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "has_number_holder",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "number_holder_initial",
    "label": "Number holder's middle initial",
    "type": "text",
    "required": false,
    "meta_class": null,
    "ui_width": "quarter",
    "group_id": "number-holder",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "has_number_holder",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "number_holder_last_name",
    "label": "Number holder's last name",
    "type": "text",
    "required": true,
    "meta_class": "name",
    "ui_width": null,
    "group_id": "number-holder",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "has_number_holder",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "number_holder_ssn_first3",
    "label": "Number holder's Social Security number — first 3 digits",
    "type": "text",
    "required": true,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "number-holder",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "has_number_holder",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "number_holder_ssn_mid2",
    "label": "Middle 2 digits",
    "type": "text",
    "required": true,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "number-holder",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "has_number_holder",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "number_holder_ssn_last4",
    "label": "Last 4 digits",
    "type": "text",
    "required": true,
    "meta_class": "ssn_last4",
    "ui_width": "third",
    "group_id": "number-holder",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "has_number_holder",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "rep_first_name",
    "label": "Representative's first name",
    "type": "text",
    "required": true,
    "meta_class": "name",
    "ui_width": null,
    "group_id": "representative-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "rep_initial",
    "label": "Representative's middle initial",
    "type": "text",
    "required": false,
    "meta_class": null,
    "ui_width": "quarter",
    "group_id": "representative-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "rep_last_name",
    "label": "Representative's last name",
    "type": "text",
    "required": true,
    "meta_class": "name",
    "ui_width": null,
    "group_id": "representative-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "rep_id",
    "label": "Representative's Rep ID",
    "type": "text",
    "required": true,
    "meta_class": null,
    "ui_width": "half",
    "group_id": "representative-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "has_multiple_reps",
    "label": "Are you appointing or keeping more than one representative?",
    "type": "checkbox",
    "required": true,
    "meta_class": "yes_no",
    "ui_width": null,
    "group_id": "representative-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "principal_rep_name",
    "label": "Full name of your principal representative",
    "type": "text",
    "required": true,
    "meta_class": "name",
    "ui_width": null,
    "group_id": "principal-representative",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "has_multiple_reps",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "claim_type_title_ii_disability",
    "label": "Disability benefits — Social Security (Title II)",
    "type": "checkbox",
    "required": true,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "claim-type",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claim_type_title_xvi_disability",
    "label": "Disability benefits — SSI (Title XVI)",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "claim-type",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claim_type_title_xvi",
    "label": "SSI benefits — non-disability (Title XVI)",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "claim-type",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claim_type_retirement",
    "label": "Retirement benefits",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "claim-type",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claim_type_medicare_svb",
    "label": "Medicare (Title XVIII) or Special Veterans Benefits (Title VIII)",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "claim-type",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claim_type_cdr",
    "label": "Continuing Disability Review (CDR)",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "claim-type",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claim_type_post_entitlement",
    "label": "An issue that came up after benefits were approved (post-entitlement)",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "claim-type",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claim_type_post_entitlement_explain",
    "label": "Describe the issue",
    "type": "text",
    "required": true,
    "meta_class": null,
    "ui_width": null,
    "group_id": "claim-type",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "claim_type_post_entitlement",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "rep_status_attorney",
    "label": "An attorney in good standing",
    "type": "checkbox",
    "required": false,
    "meta_class": "radio",
    "ui_width": null,
    "group_id": "representative-status",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "rep_status_nonattorney_direct",
    "label": "A non-attorney who is eligible for direct payment",
    "type": "checkbox",
    "required": false,
    "meta_class": "radio",
    "ui_width": null,
    "group_id": "representative-status",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "rep_status_nonattorney_no_direct",
    "label": "A non-attorney who is not eligible for direct payment",
    "type": "checkbox",
    "required": false,
    "meta_class": "radio",
    "ui_width": null,
    "group_id": "representative-status",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "rep_disclosure_disbarred",
    "label": "Disbarred or suspended from a court or bar",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "representative-status",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "rep_disclosure_disqualified",
    "label": "Disqualified from appearing before a federal program or agency",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "representative-status",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "rep_disclosure_removed",
    "label": "Removed from practice, or had a professional license suspended",
    "type": "checkbox",
    "required": false,
    "meta_class": "multi_select",
    "ui_width": null,
    "group_id": "representative-status",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "rep_disclosure_disbarred_explain",
    "label": "Explain the disbarment or suspension",
    "type": "text",
    "required": false,
    "meta_class": null,
    "ui_width": null,
    "group_id": "representative-status",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "rep_disclosure_disbarred",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "rep_disclosure_disqualified_explain",
    "label": "Explain the disqualification",
    "type": "text",
    "required": false,
    "meta_class": null,
    "ui_width": null,
    "group_id": "representative-status",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "rep_disclosure_disqualified",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "rep_disclosure_removed_explain",
    "label": "Explain the removal or license suspension",
    "type": "text",
    "required": false,
    "meta_class": null,
    "ui_width": null,
    "group_id": "representative-status",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "rep_disclosure_removed",
      "operator": "truthy"
    },
    "compound_subfields": null
  },
  {
    "id": "affiliate_no_ein",
    "label": "No firm or organization is being designated (No EIN)",
    "type": "checkbox",
    "required": false,
    "meta_class": "plain_checkbox",
    "ui_width": null,
    "group_id": "affiliation-certifications",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "affiliate_ein_first2",
    "label": "Firm's EIN — first 2 digits",
    "type": "text",
    "required": false,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "affiliation-certifications",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "affiliate_no_ein",
      "operator": "falsy"
    },
    "compound_subfields": null
  },
  {
    "id": "affiliate_ein_last7",
    "label": "Firm's EIN — last 7 digits",
    "type": "text",
    "required": false,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "affiliation-certifications",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "affiliate_no_ein",
      "operator": "falsy"
    },
    "compound_subfields": null
  },
  {
    "id": "affiliate_entity_name",
    "label": "Firm or organization name",
    "type": "text",
    "required": false,
    "meta_class": null,
    "ui_width": null,
    "group_id": "affiliation-certifications",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "affiliate_no_ein",
      "operator": "falsy"
    },
    "compound_subfields": null
  },
  {
    "id": "assignment_direct_payment",
    "label": "Pay the authorized fee directly to the firm named above (assignment)",
    "type": "checkbox",
    "required": false,
    "meta_class": "radio",
    "ui_width": null,
    "group_id": "affiliation-certifications",
    "choice_group": null,
    "choice_label": null,
    "visibility": {
      "fieldId": "affiliate_no_ein",
      "operator": "falsy"
    },
    "compound_subfields": null
  },
  {
    "id": "assignment_rescind",
    "label": "Cancel a prior assignment — pay the representative directly (rescission)",
    "type": "checkbox",
    "required": false,
    "meta_class": "radio",
    "ui_width": null,
    "group_id": "affiliation-certifications",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "rep_cert_initials",
    "label": "Representative's initials",
    "type": "text",
    "required": false,
    "meta_class": null,
    "ui_width": "quarter",
    "group_id": "affiliation-certifications",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "fee_request_direct_payment",
    "label": "Request a fee, deducted from past-due benefits and paid directly by SSA",
    "type": "checkbox",
    "required": false,
    "meta_class": "radio",
    "ui_width": null,
    "group_id": "fee-arrangement",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "fee_request_no_direct_payment",
    "label": "Request a fee, but collect it without direct payment from SSA",
    "type": "checkbox",
    "required": false,
    "meta_class": "radio",
    "ui_width": null,
    "group_id": "fee-arrangement",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "fee_waive_third_party",
    "label": "Waive any fee from you — a third-party entity pays instead",
    "type": "checkbox",
    "required": false,
    "meta_class": "radio",
    "ui_width": null,
    "group_id": "fee-arrangement",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "fee_waive",
    "label": "Waive the fee entirely — no one pays a fee",
    "type": "checkbox",
    "required": false,
    "meta_class": "radio",
    "ui_width": null,
    "group_id": "fee-arrangement",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "has_other_claimants",
    "label": "Do family members (a spouse or child) get benefits on this claim without their own representative?",
    "type": "checkbox",
    "required": false,
    "meta_class": "yes_no",
    "ui_width": null,
    "group_id": "fee-arrangement",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_1_name",
    "label": "Family member 1 — full name",
    "type": "text",
    "required": true,
    "meta_class": "name",
    "ui_width": null,
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_1_ssn_first3",
    "label": "Family member 1 — SSN, first 3 digits",
    "type": "text",
    "required": true,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_1_ssn_mid2",
    "label": "Middle 2 digits",
    "type": "text",
    "required": true,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_1_ssn_last4",
    "label": "Last 4 digits",
    "type": "text",
    "required": true,
    "meta_class": "ssn_last4",
    "ui_width": "third",
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_2_name",
    "label": "Family member 2 — full name",
    "type": "text",
    "required": false,
    "meta_class": "name",
    "ui_width": null,
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_2_ssn_first3",
    "label": "Family member 2 — SSN, first 3 digits",
    "type": "text",
    "required": false,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_2_ssn_mid2",
    "label": "Middle 2 digits",
    "type": "text",
    "required": false,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_2_ssn_last4",
    "label": "Last 4 digits",
    "type": "text",
    "required": false,
    "meta_class": "ssn_last4",
    "ui_width": "third",
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_3_name",
    "label": "Family member 3 — full name",
    "type": "text",
    "required": false,
    "meta_class": "name",
    "ui_width": null,
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_3_ssn_first3",
    "label": "Family member 3 — SSN, first 3 digits",
    "type": "text",
    "required": false,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_3_ssn_mid2",
    "label": "Middle 2 digits",
    "type": "text",
    "required": false,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_3_ssn_last4",
    "label": "Last 4 digits",
    "type": "text",
    "required": false,
    "meta_class": "ssn_last4",
    "ui_width": "third",
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_4_name",
    "label": "Family member 4 — full name",
    "type": "text",
    "required": false,
    "meta_class": "name",
    "ui_width": null,
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_4_ssn_first3",
    "label": "Family member 4 — SSN, first 3 digits",
    "type": "text",
    "required": false,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_4_ssn_mid2",
    "label": "Middle 2 digits",
    "type": "text",
    "required": false,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "other_claimant_4_ssn_last4",
    "label": "Last 4 digits",
    "type": "text",
    "required": false,
    "meta_class": "ssn_last4",
    "ui_width": "third",
    "group_id": "other-claimants",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "page4_claimant_ssn_first3",
    "label": "Your SSN — first 3 digits (top of page 4)",
    "type": "text",
    "required": true,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "step-page-ids",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "page4_claimant_ssn_mid2",
    "label": "Middle 2 digits (page 4)",
    "type": "text",
    "required": true,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "step-page-ids",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "page4_claimant_ssn_last4",
    "label": "Last 4 digits (page 4)",
    "type": "text",
    "required": true,
    "meta_class": "ssn_last4",
    "ui_width": "third",
    "group_id": "step-page-ids",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "page4_rep_id",
    "label": "Representative's Rep ID (top of page 4)",
    "type": "text",
    "required": true,
    "meta_class": null,
    "ui_width": "half",
    "group_id": "step-page-ids",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "page5_claimant_ssn_first3",
    "label": "Your SSN — first 3 digits (top of page 5)",
    "type": "text",
    "required": true,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "step-page-ids",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "page5_claimant_ssn_mid2",
    "label": "Middle 2 digits (page 5)",
    "type": "text",
    "required": true,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "step-page-ids",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "page5_claimant_ssn_last4",
    "label": "Last 4 digits (page 5)",
    "type": "text",
    "required": true,
    "meta_class": "ssn_last4",
    "ui_width": "third",
    "group_id": "step-page-ids",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "page5_rep_id",
    "label": "Representative's Rep ID (top of page 5)",
    "type": "text",
    "required": true,
    "meta_class": null,
    "ui_width": "half",
    "group_id": "step-page-ids",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "page6_claimant_ssn_first3",
    "label": "Your SSN — first 3 digits (top of page 6)",
    "type": "text",
    "required": true,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "step-page-ids",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "page6_claimant_ssn_mid2",
    "label": "Middle 2 digits (page 6)",
    "type": "text",
    "required": true,
    "meta_class": "number",
    "ui_width": "third",
    "group_id": "step-page-ids",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "page6_claimant_ssn_last4",
    "label": "Last 4 digits (page 6)",
    "type": "text",
    "required": true,
    "meta_class": "ssn_last4",
    "ui_width": "third",
    "group_id": "step-page-ids",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "page6_rep_id",
    "label": "Representative's Rep ID (top of page 6)",
    "type": "text",
    "required": true,
    "meta_class": null,
    "ui_width": "half",
    "group_id": "step-page-ids",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claimant_signature",
    "label": "Your signature",
    "type": "signature",
    "required": true,
    "meta_class": null,
    "ui_width": null,
    "group_id": "signatures",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "claimant_signature_date",
    "label": "Date",
    "type": "text",
    "required": false,
    "meta_class": "date",
    "ui_width": "third",
    "group_id": "signatures",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "representative_signature",
    "label": "Representative's signature",
    "type": "signature",
    "required": true,
    "meta_class": null,
    "ui_width": null,
    "group_id": "signatures",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "representative_signature_date",
    "label": "Date",
    "type": "text",
    "required": false,
    "meta_class": "date",
    "ui_width": "third",
    "group_id": "signatures",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  }
]
```

## Sources
- [SSA — Representing SSA claimants](https://www.ssa.gov/representation/)
- [SSA — 2024 registration rule for representatives](https://www.ssa.gov/representation/2024NewRule.htm)
- [SSA — e1696 online appointment portal](https://secure.ssa.gov/ssa1696/front-end/)
- [Official instructions](https://www.ssa.gov/forms/ssa-1696.html)
- [Official PDF](https://www.ssa.gov/forms/ssa-1696.pdf)

## Last verified
2026-07-12


## FAQs
- **Where do I send Form SSA-1696?** To the Social Security office handling your claim — there is no single national mailing address. Use the return address printed on your SSA letters about the claim, or look up your local field office at ssa.gov/locator. If a hearing office has your case, use that office’s address.
- **Does my representative need to be registered with SSA?** Yes. Since September 30, 2024, anyone not previously registered must register (Form SSA-1699) and receive a Rep ID before SSA will recognize a new appointment. The Rep ID goes on this form.
- **Can we file the SSA-1696 online instead?** Yes — SSA’s e1696 portal lets you and your representative complete, e-sign, and submit the form electronically. It requires both of you to participate online; the mailed paper form is the alternative when that is not practical.
- **Who has to sign?** For a new appointment, both you and your representative sign Section 8. For updates, the signature depends on the section being updated — your signature for Section 3, your representative’s for Section 5, and both for Sections 4, 6, or 7.
- **Does it cost anything to appoint a representative?** The form is free. Any fee your representative charges for their services must generally be authorized by SSA, and the fee arrangement you record on this form tells SSA how the representative expects to be paid.
- **Can I appoint more than one representative?** Yes, but SSA requires a separate SSA-1696 for each representative. If you have several, this form also lets you name your principal representative — the one SSA contacts.


## Related
- [SSA-795 — Statement of Claimant or Other Person](/forms/ssa-795)
- [SSA-827 — Authorization to Disclose Information to SSA](/forms/ssa-827)
- [Form SS-5 — Application for a Social Security Card](/forms/ss-5)
- [SSA-3288 — Consent for Release of Information](/forms/ssa-3288)
- [Form SSA-44 — Medicare IRMAA Reduction Request (Life-Changing Event)](/forms/ssa-44)
- [SSA-7008 — Request for Correction of Earnings Record](/forms/ssa-7008)