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Representation Forms Checklist

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The following forms should be submitted as part of your representation package to SSA

  1. SSA-1696
  2. SSA-1695
  3. Fee Agreement
  4. Signed SSA-827

These forms, once signed by the client and representative, can be submitted via fax, mailed, or hand-delivered. Make sure to get a stamped copy if you hand deliver the package. Make a file copy and a copy for submission.

Optional Forms (Do Not Submit To SSA)

  1. Hi-Tech Release Form
  2. HIPAA Release Form


These forms are found in the standard representation forms packages in Dibcase. These forms can also be printed individually.


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