SSA-1699

Registration For Appointed Representative Services And Direct Pay

Download and Print the SSA-1699

Purpose of Form
Complete this form if you:
·
Complete this form and fax it to the Office of Central Operations at 1-570-270-7307. Do not fax more than one Form SSA-1699 at a time.
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You will receive a notice containing your Representative Identification (Rep ID) once your initial registration is complete. Allow 2 to 3 weeks to receive your notice.
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If you are currently suspended or disqualified from representing claimants in dealings with the Social Security Administration, you may not register until your suspension has ended or we have reinstated you.
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You must update your registration by completing a new form if your personal, professional, or business affiliation information changes including information related to disbarments, suspensions, or sanctions.
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We may return incomplete or inaccurate forms.
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For more information, please call 1-800-772-6270 or visit our website at
www.socialsecurity.gov/ar
. If you are hearing impaired, call our TTY number at 1-800-325-0778. You may also visit your local Social Security office.
·
want to register for direct payment of fees,
·
registered for direct payment of fees prior to 10/31/2009 and need to update your information,
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registered as an appointed representative on or after 10/31/2009 and need to update your information, or
·
received a notice from the Social Security Administration instructing you to complete this form.
NOTE: If you are not in the business of providing services to Social Security claimants and beneficiaries, but will be appointed as a representative for a relative, friend, or other acquaintance, YOU DO NOT NEED TO COMPLETE THIS FORM. This form also collects information necessary to conform to Internal Revenue Code sections 6041 and 6045(f), which require us to issue IRS Form 1099-MISC to individuals who represent claimants and receive direct payment of $600 or more during a tax year.
General Information and Instructions
Explanation of Terms for Completing This Form
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Representative – an attorney or individual other than an attorney who meets all of our requirements and is appointed to represent claimants in dealings with us.
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Representative Identification

And much more...