·         Name of project.

Appointed Representatives

·      Unique project identifier.


·      Privacy Impact Assessment Contact.


Office of Payment and Claimant Representative Policy

Office of Income Security Programs

Social Security Administration

6401 Security Boulevard

Baltimore, MD  21235

·         Background.

The Appointed Representative File is a system of records that covers the information about appointed representatives and their activities that we collect, maintain, and use.  A representative may be any person (e.g., attorney, eligible direct pay non-attorney, or non-professional such as a friend, neighbor, or minister), a firm, or other professional entity that provides representative services, regardless of whether the representative charges or collects a fee for providing the representational services.

In early 2008, we developed an automated disability claims and services process to make it easier for appointed representatives to do business with us electronically.  For example, to 1) simplify the online application process, 2) establish an online suite of services for representatives, and 3) receive application data and medical records electronically from third parties and medical service providers.

In October 2009, we implemented the online suite of services process that not only establishes a framework of new business processes and systems enhancements, but also makes comprehensive online services available for representatives who wish to perform services on behalf of our claimants.

·         Describe the information we plan to collect, why we will collect the information, how we intend to use the information, and with whom we will share the information.

We collect the following information for the appointed representative process:

Business Entity Taxpayer Information.  Currently, entities complete and file a Form SSA-1694 Request for Business Entity Taxpayer Information.  The information we collect on the Form SSA-1694 includes the entity’s business name, employer identification number, and tax mailing address.  We request this information if the entity would like us to provide an informational Form 1099-MISC for fee payments we make to the representative associated with the entity. 

In 2010, we will begin to recognize entities as representatives.  At that time, the Form SSA-1694 may become obsolete and entities may register and update their registration information with us online.  We will expand the information we collect about entities to include notice mailing address, payment, entity official, entity administrator, and affiliate information.  We will use the information we collect to recognize entity representatives and, as appropriate, direct pay and issue Form

1099-MISC to entity representatives.

Request for Direct Payment.  Currently, we require representatives to complete a Form SSA-1695 Identifying Information for Possible Direct Payment of Authorized Fees for each claim for which they wish to receive direct payment.  The information we collect on the Form SSA-1695, which is specific to the claimant, the wage earner (if different from the claimant), the representative, and the representative’s employer (if the representative is an employee of an entity), allows us to establish a link between claimants and representatives for direct payment purposes. 

In 2010, the information we collect on the Form SSA-1695 will be collected on the Form SSA-1696 Appointment, Revocation, or Withdrawal of a Representative – previously entitled Appointment of Representative.  However, we will continue to use the Form SSA-1695 until it is no longer needed in the process.  We will also no longer collect the representative’s Social Security number.  Instead, we will collect and use the representative’s assigned identification number. 

Appointment of RepresentativeCurrently, representatives or claimants may complete and submit a Form SSA-1696 to appoint a representative.  The information we collect on the Form SSA-1696 Appointment of Representative includes the claimant, wage earner (if different from the claimant), and the representative.

In 2010, we will expand the purpose for which we use the Form SSA-1696 to include revocation and withdrawal of appointments.  We will also change the name of the Form SSA-1696 from Appointment of Representative to Appointment, Revocation, or Withdrawal of a Representative to more accurately reflect the expanded use.  In addition to using the form for appointment purposes, claimants also may use it to revoke appointments.  Further, representatives will use it to withdraw appointments.  

Direct Payment RegistrationCurrently, we require appointed representatives to file a Form SSA-1699 Request for Appointed Representatives Direct Payment Information to register for direct payment of authorized fees.  We use the Form

SSA-1699 to collect personally identifiable information, professional information, and business information, which includes existing business affiliations as an appointed representative.  We require this information for representatives to register for direct payment and receipt of the Form 1099-MISC information return. 

In October 2009, we expanded the use of the Form SSA-1699 to allow persons who want to conduct business with us either as an appointed representative or on behalf of an appointed representative to register with us, or to access our business services online application.  Representatives who want to register for direct pay or update direct payment information may do so on paper or online.  Persons who want to access our electronic services must complete the online registration process. We also changed the name of the Form SSA-1699 from Request for Appointed Representatives Direct Payment Information to Registration of Individuals and Staff for Appointed Representative Services to more appropriately reflect the expanded purpose.    

In 2010, we will require those representatives who want to receive direct payment for representation on a claim to complete the online registration process.   Since we will also recognize entities as representatives, persons who want to provide advocacy services on behalf of an entity or access our electronic services on behalf of an entity must register with us online. 

We will maintain the information we collect under these categories in the Appointed Representative database.  We will disclose information in the database only to the subject of the record, under a routine use, or as otherwise required by Federal law.  For example, under a routine use, we disclose information to contractors, as necessary, to assist us in efficiently administering our programs.  A full list of routine uses applicable to this information collection may be found in the Appointed Representative File system of records notice, 60-0325.

·      Describe the administrative and technological controls that we have in place or that we plan to secure the information we will collect.

We maintain information in the Appointed Representative database in electronic form.  We keep related paper records in locked cabinets or in other secure areas.  We safeguard the security of the electronic information by requiring the use of access codes to enter the computer system that house the data.  

We annually provide appropriate security awareness training to all of our employees and contractors that includes reminders about the need to protect personally identifiable information and the criminal penalties that apply to unauthorized access to, or disclosure of, personally identifiable information.  See 5 U.S.C. § 552a(i)(1).  Furthermore, employees and contractors with access to databases maintaining personally identifiable information must annually sign a sanction document, acknowledging their accountability for inappropriately accessing or disclosing such information.

·      Describe the impact on people’s privacy rights.  Do we afford people an opportunity to decline to provide information?

Yes.  We collect, maintain, and use information only where we have specific legal authority to do so in order to administer our responsibilities under the Social Security Act.  When we collect a person’s information, we advise that person of our legal authority for requesting the information, the purpose for which we will use and disclose the information, and explain the consequences should the person choose not to provide the information.  The person can then make an informed decision as to whether or not to provide the information.

Do we afford people an opportunity to consent to only particular uses of the information?

No.  When we collect a person’s information, we advise that person of the purposes for which we will use the information.  We further advise the person that we will disclose the information without prior written consent only when we have specific legal authority to do so (e.g., the Privacy Act).   We do not otherwise offer persons an opportunity to determine how and with whom we will share their information.

·       Does the collection of this information require a new system of records under the Privacy Act (5 U.S.C. § 552a) or an alteration to an existing system of records?

Yes.  This collection of information required us to alter an existing system of records, the Attorney and Eligible Direct PayNon-Attorney (EDPNA)1099-MISC File (60-0325).  The system of records was renamed the Appointed Representative File.  (See 74 FR 51940 (October 8, 2009)).  The alteration appropriately reflects the persons and entities covered by the system as well as the purpose for which we collect, maintain, and use the information in the Appointed Representative database and covered by the Appointed Representative File system of records. 


/s/ Dawn S. Wiggins                                             February 3, 2010

SIGNATURE                                                       DATE


/s/ David F. Black                                                 February 4, 2010

SIGNATURE                                                       DATE

Privacy Policy