I-1-2-95.Handling a Form SSA-1695 for Direct Payment of Fees

The form SSA-1695, Identifying Information for Possible Direct Payment of Authorized Fees, is now obsolete, and has been incorporated into form SSA-1696. If the Office of Hearing Operations (OHO) or the Office of Appellate Operations (OAO) receives a form SSA-1695 staff will follow the below instructions as well as those contained in EM-20004. OHO staff will follow the instructions in SHOP section 1.3.5.1.

Form SSA-1695 was used by an appointed representative who is eligible for and wants to receive payment of an authorized fee directly from a claimant's past-due benefits. A representative may still submit this form at the same time he or she submits a form SSA-1696, Appointment of Representative, or an equivalent writing. For more information about appointments, see Hearings, Appeals and Litigation Law manual I-1-1-11.

An SSA-1695 contains personally identifiable information (PII) about the representative, including the representative's Social Security number (SSN), and is pertinent only for payment purposes. Therefore, on receipt of an SSA-1695, it is critical that staff or adjudicators in the OHO and OAO not associate the form with a claim(s) file or exhibit the document.

Rather, when a representative submits an SSA-1695 to an OHO or OAO office, staff will immediately redirect the form to the field office (FO). The FO will use a black marker to mask the representative's SSN completely and mark the form “processed.” The FO will then associate the processed form with the claim(s) file. For FO instructions, see EM-12004 REV 3.

If OHO or OAO staff discovers an unprocessed SSA-1695 in a claim(s) file, OHO or OAO staff will immediately remove the document from the claim(s) file and send the form to the FO for processing. In a paper claim(s) file, OHO or OAO staff will “remove” the form by simply removing it from the claim(s) file and sending the form to the FO. However, if the claim(s) file is electronic, OHO or OAO staff will “remove” the form by moving it to the C section (Current Development/Temporary) of the claim(s) file. This action will result in the permanent removal of the unprocessed form at the time the case is closed.

There are unique circumstances involved if OHO or OAO mistakenly exhibits an unprocessed SSA-1695. For this situation, consult internal business processes or speak with a supervisor.