Social Security Administration Representative Appointment Form
This file is used to appoint a representative to act on your behalf in matters related to Social Security claims. It includes instructions on how to complete the form and information about representation fees. The form must be submitted to the Social Security Administration.
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How do I fill this out?
To fill out this form, start by entering your full name and Social Security number at the top. Next, provide the name and address of the person you are appointing as your representative. Ensure all required signatures and dates are included before submission.
How to fill out the Social Security Administration Representative Appointment Form?
1
Enter your full name and Social Security number at the top.
2
Provide the name and address of your appointed representative.
3
Specify the Social Security programs related to your claim.
4
Sign and date the form.
5
Submit the completed form to your local Social Security office.
Who needs the Social Security Administration Representative Appointment Form?
1
Individuals appointing a representative for their Social Security claims.
2
Representatives accepting the appointment to act on behalf of a claimant.
3
Claimants who need assistance with their Social Security matters.
4
Non-attorneys participating in the direct fee payment demonstration project.
5
Attorneys or non-attorneys waiving their right to charge and collect fees.
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What are the instructions for submitting this form?
To submit this form, send the completed form to your local Social Security office. You can find the office address in the U.S. Government section of your telephone directory or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). Alternatively, you can send the form to SSA, 6401 Security Boulevard, Baltimore, MD 21235-6401.
What are the important dates for this form in 2024 and 2025?
For the years 2024 and 2025, ensure all submissions are made by December 31st of each year to avoid any delays or penalties.
What is the purpose of this form?
The purpose of this form is to officially appoint a representative to act on your behalf in Social Security matters. By completing and submitting this form, you authorize your representative to handle requests, provide evidence, and receive notices related to your claims. Properly appointing a representative ensures effective management of your Social Security affairs and compliance with SSA procedures.
Tell me about this form and its components and fields line-by-line.
- 1. Name (Claimant): Enter the full name of the claimant.
- 2. Social Security Number: Provide the claimant's Social Security number.
- 3. Wage Earner (If Different): Enter the name and Social Security number of the wage earner if different from the claimant.
- 4. Appointment of Representative: Provide the name and address of the person being appointed as the representative.
- 5. Program(s) under which the claim is filed: Indicate the Social Security programs related to the claim.
- 6. Authorization: Authorize the SSA to release information to the representative and associated parties.
- 7. Representative's Acceptance: The appointed representative must accept the appointment by providing their name, signature, and other required information.
- 8. Waiver of Fee (Optional): The representative may waive their right to charge and collect a fee by completing this section.
- 9. Waiver of Direct Payment (Optional): The representative may waive their right to direct payment of a fee by completing this section.
- 10. Signatures and Dates: Both the claimant and the representative must sign and date the form to validate it.
What happens if I fail to submit this form?
Failing to submit the form may result in the SSA not recognizing your appointed representative, causing delays in handling your claims.
- Unrecognized Representative: The SSA will not acknowledge the representative, causing communication issues.
- Delayed Claims Processing: There may be delays in processing your claims without a recognized representative.
- Missed Deadlines: Important deadlines may be missed if the representative cannot act on your behalf.
How do I know when to use this form?
- 1. Appointing a Representative: When you want to officially appoint someone to represent you.
- 2. Changing Representatives: When you need to replace your current representative.
- 3. Authorizing Information Release: When you need to authorize the SSA to release information to your representative.
- 4. Waiving Fees: When your representative decides to waive their right to charge and collect a fee.
- 5. Direct Payment Waiver: When your representative waives their right to direct payment.
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Do I need to complete all parts of the form?
You should complete all required sections of the form, but optional parts can be filled out based on your specific needs.
Can I appoint more than one representative using this form?
Yes, you can appoint more than one representative and specify the main representative if needed.
How do I submit the completed form?
Submit the completed form to your local Social Security office, either in person or by mail.
Is there a fee for appointing a representative?
The form itself does not require a fee, but the appointed representative may charge a fee which must be approved by the SSA.
Can a non-attorney be appointed as a representative?
Yes, both attorneys and non-attorneys can be appointed as representatives using this form.
How do I know if my representative is qualified?
Ensure your representative is qualified by checking their experience and confirming they are not disqualified from representing claimants before the SSA.
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