Disability attorneys are paid from your back-pay (usually 25% up to $7,200) — no upfront cost

You can change representatives at any time by filing a new SSA-1696

Non-attorney representatives must be registered with SSA

Social Security Disabilityeasy

Appointment of Representative

SSA-1696 · SSA

Designates an attorney or non-attorney representative to act on the claimant's behalf in SSA disability proceedings.

Form Details

Total fields: 18
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Filled by: both
Frequency: one time

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Where to Submit This Form

🌐

SSA.gov

https://www.ssa.gov/representation/

Your representative can submit this electronically.

📬

Mail to your local SSA office

https://secure.ssa.gov/ICON/main.jsp

🏢

In person at local SSA office

https://secure.ssa.gov/ICON/main.jsp

Required Attachments

📎 Signed by both the claimant and the representative
📎 Fee agreement or fee petition (if representative charges a fee)

Processing Time

Processed within a few days. Your representative will receive access to your case file.

What Happens Next

SSA will send all correspondence to both you and your representative. Your representative can submit evidence and attend hearings on your behalf.

Tips for This Form

✓ Disability attorneys are paid from your back-pay (usually 25% up to $7,200) — no upfront cost
✓ You can change representatives at any time by filing a new SSA-1696
✓ Non-attorney representatives must be registered with SSA

More Social Security Disability Forms

SSDI Application

SSA-16-BK · SSA

Application for Social Security Disability Insurance Benefits. Requires detailed work history, earnings record, and medical condition documentation.

SSI Application

SSA-8000-BK · SSA

Application for Supplemental Security Income for aged, blind, and disabled individuals with limited income and resources. Must be completed via SSA interview.

Adult Disability Report

SSA-3368-BK · SSA

The most complex patient-facing disability form. 15 pages requiring complete medical history, all diagnoses, medications, treating providers, hospitalizations, and work history.

Work History Report

SSA-3369-BK · SSA

10-page report requiring detailed descriptions of all jobs held in the past 15 years including physical demands, tools used, supervision, and lifting requirements.

Function Report

SSA-3373-BK · SSA

10-page functional assessment covering ADL capacity, daily routines, social functioning, cognitive abilities, and physical limitations.

Authorization to Disclose Information

SSA-827 · SSA

Authorization allowing SSA to collect medical and other information from providers, hospitals, and other sources for disability determination.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the SSA or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.