(light piano music)
- [Instructor] Hello.
Today, we will be discussing
how to complete the SSA-1696,
which is also called
the Appointment of a Representative Form.
Completing and submitting the SSA-1696 form
is an important part
of a SOAR-assisted SSI and SSDI application.
It allows the Social Security Administration, SSA,
and the Disability Determination Services, DDS,
to communicate with you,
the SOAR provider
about the applicant's SSI and SSDI application.
It also allows you to call SSA and DDS
throughout the application process
for status updates,
and it allows you to provide SSA and DDS
with additional information
during the application process,
such as the applicant's medical records
and the SOAR medical summary report.
Remember that the SSA-1696 form
should not be submitted to SSA
before an SSI and SSDI application has been submitted.
It should be submitted
with the complete SSI and SSDI application packet.
You want to make sure
you complete the SSA-1696 form correctly
or SSA will be unable to process the form
and add you as a representative
for the applicant's application.
At the top of each page of the SSA-1696,
provide the applicant's Social Security number.
If you have an appointed representative rep ID,
provide that at the top of each page as well.
If you don't have a rep ID,
leave this blank.
In Section 1,
help the applicant enter their full name
and complete mailing address and phone number.
If the applicant does not have a mailing address
or phone number,
enter your agency's address and phone number.
Do not leave this blank or enter homeless.
Leave the Number Holder's Information portion
of this section blank
unless the applicant's disability claim
is based on another person's work earnings.
The applicant can check the box in Section 2
if they approve of SSA
releasing information
about their pending disability claim
to other staff at your agency
who may be assisting with the application.
In Section 3,
If you are the only representative for the applicant,
this section should be left blank.
In Section 4,
the SOAR provider will enter their full name
and complete agency mailing address and phone number.
In the Representative's Status Part A portion
of Section 5,
check one option only.
Most SOAR providers will choose,
"I am a non-attorney not eligible for direct payment."
In the Representative's Status Part B portion
of Section 5,
check yes or no for these two questions.
Do not skip these questions.
Since you will not be seeking a fee for SOAR assistance,
the Affiliation Information portion of Section 5
will be left blank.
Then make sure to sign with your initials
at the bottom of Section 5.
Most SOAR providers representing adult applicants
will only check the third box in Section 6,
which reads,
"Concurrent Title II and Title XVI Disability Benefits."
This allows you to represent the applicant
for both their SSI and SSDI claims.
For child SSI claims,
you will only check the second box that reads,
"Claim/appeal for Title XVI Disability Benefits."
Do not check all the boxes in this section.
This may cause SSA to reject the form.
You should only check the issues
the applicant needs representation for.
In Section 7,
check the last box which reads,
"I waive the right to a fee,"
since you will not be seeking a fee for SOAR assistance.
Then finally,
make sure that both you and the applicant
sign and date the SSA-1696 form in Section 8.
Thank you for your interest in this topic
and thank you for being a SOAR provider.