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

Last Update: 4/11/16 (Transmittal I-1-85)

The form SSA-1695, Identifying Information for Possible Direct Payment of Authorized Fees, is 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 often submits 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 Office of Disability Adjudication and Review (ODAR) not associate the form with a claim(s) file or exhibit the document.

Rather, when a representative submits an SSA-1695 to an ODAR office, ODAR 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.

NOTE:

ODAR will not delay case adjudication pending FO action. Because the form relates only to possible payment issues, the processing of the form has no bearing on ODAR's adjudication of a claim(s).

If ODAR staff discovers an unprocessed SSA-1695 in a claim(s) file, ODAR 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, ODAR 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, ODAR 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 ODAR mistakenly exhibits an unprocessed SSA-1695. For this situation, ODAR management at both the hearings and Appeals Council levels will provide internal processing instructions on how to appropriately mask the exhibited form based on current systems capabilities. (Even in this situation, ODAR will still forward an unmasked copy to the FO.) To reduce the likelihood of inadvertently releasing the representative's PII to the claimant, ODAR will not continue adjudicating the case until it has taken the necessary actions to mask the exhibited form.