Form SSA-1699 Registration for Appointed Representative Services and Direct Payment

Form SSA-1699 Instructions

The SSA-1699 Form consists of several parts, each one of them is dedicated to a different subject. These parts include the following details:

1. General Information and Instructions . The first section of the form provides the individual with guidelines on how to complete the form. Here, they can learn how to submit it, what will happen if the form will be incomplete, and how to obtain more information about the form if they need it.
2. Privacy Act Statement . This statement informs the individual how their personal information they designate in the document will be used and kept. Here, individuals can also learn about cases when the information can be disclosed to others.
3. Personal Identification and Contact Details . Individuals must use this part of the document to designate their personal information, which includes their name, date of birth, and Social Security Number. Additionally, they must indicate their personal contact information which consists of their mailing address, telephone number, fax number, and email address.
4. Representative Information . Here the individual must indicate the information of the representative. It must contain an address for receipts and notices, telephone number, fax number, and email address they use for business purposes. In addition to this, the individual must designate the preferred method of payment and their tax address.
5. Perjury Statement . At the end of the form, the individual must declare that the information in the form is true and correct, sign, and date the document.

SSA Form-1699 contains other sections as well, such as a Paper Reduction Act Statement, Bar Information, Organization Details, Attestations, and more.