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Form SSA-1695-F3 Identifying Information for Possible Direct Payment of Authorized Fees
What Is Form SSA-1695?
Form SSA-1695-F3, Identifying Information for Possible Direct Payment of Authorized Fees , is a form used to collect information in order to facilitate direct payments of an authorized fee. The form was last revised by the U.S. Social Security Administration (SSA) on February 1, 2019 . An SSA-1695 fillable form is available for download and digital filing below.
Alternate Names:
- Form SSA-1695;
- SSA Form 1695.
If you are an attorney who represents a claimant before the SSA in connection with the claimant's application to the SSA or if you are a non-attorney claimant's representative who meets the requirements, you have a right to request a fee for your services. If you want to receive direct payments from the SSA, you should first receive their approval. Direct payments mean that you receive an appropriate fee not through your client, but directly from your client's past-due benefits paid by the SSA. For this purpose, you need to complete Form SSA-1699, Request for Appointed Representative Services and Direct Payment, along with the SSA-1695-F3.
Form SSA-1695-F3 Instructions
Submit Form SSA-1699 each time you are appointed to represent a claimant. If you did not register when the claim was pending with the SSA, submit this form each time a federal court approves your fee. If you do not provide the SSA with identifying information for a possible direct payment requested via this form or provide it only partially, your payments may be rejected.
Detailed instructions for completing the SSA Form 1695-F3 and a Privacy Act Statement can be found on the second and third pages of the form. Step-by-step filing instructions are provided below:
- Specify the name and Social Security Number (SSN) of the client you represent.
- If the claim filed is based on the record of a person other than your client, indicate their name and SSN.
- Specify, for which type of benefits you represent your client by checking the appropriate box.
- Indicate your SSN, mailing address, and name as shown on your Social Security card; if you have changed your last name for to any reason, ask the officials at your local SSA to change it in your Social Security record as well.
- If you are representing your client as an employee or partner of a company or other business entity, provide the Employer Identification Number (EIN) of this business entity. The EIN you provide allows the SSA to send this business IRS Form 1099-MISC, Miscellaneous Income (required for tax purposes).
- If you represent any other clients regarding this claim, provide their names and SSNs on the bottom part of the form. If you represent more than five clients, provide their information on a separate sheet and attach it to this form.
Send or take the completed form to your local Social Security office. Find the address of your local office through the SSA official website or by calling the SSA at the phone number indicated on the third page of the form. The list of the Social Security offices is provided in the telephone directory under U.S. Government agencies.
Download Form SSA-1695-F3 Identifying Information for Possible Direct Payment of Authorized Fees
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