Social Security

Welcome

To comply with the Internal Revenue Code (§§ 6041(a) and 6045(f)) and the Debt Collection Improvement Act of 1996, as codified at 31 U.S.C. §§ 3325 and 7701, we are requiring appointed representatives to provide taxpayer identification information as a prerequisite for receiving direct fee payment. As a service, we are providing representatives with the means to receive payments via direct deposit.

Beginning in January 2010, we will mail a Form 1099-MISC to each representative who received, by direct payment from the Social Security Administration, aggregate fees of $600 or more in the previous calendar year.

If you are a representative who is associated with a law firm, partnership, corporation, or multi-member LLC/LLP (LLC — Limited Liability Company, LLP — Limited Liability Partnership) that has attorneys and/or non-attorney representatives as partners or employees, that entity also may provide us with its taxpayer identification information using the Form SSA-1694, Request for Business Entity Taxpayer Information.

Note: SSA does not make direct fee payment to business entities.

Who Should Complete This Form?

You should complete this if you are:

• An attorney, or
• A non-attorney representative who is eligible for direct payment.

Information You Will Need

Be prepared to provide us with the following information:

• Your Social Security Number,
• Your tax mailing address,
• Name and location of a court to which you have been admitted to practice law and are currently in good standing (if applicable),
• Bank routing number and account number for direct deposit payments (if applicable), and
• The Employer Identification Number (EIN) for the business(es) with which you are affiliated.

Minimum System Requirements

To complete this report online, you will need:

• A Windows-based personal computer (Presently, this report does not support the Macintosh platform or WebTV.)
• Adobe Acrobat Reader (To download a free copy, go to http://www.adobe.com/downloads.)

Fax a completed paper Form SSA-1699, Registration for Appointed Representative Services and Direct Payment, to the Office of Central Operations at 1-570-270-7307.

Privacy Statement

The Social Security Administration is allowed to collect the facts on this application under § 6045(f) of the Internal Revenue Code and §§ 206 and 1631(d)(2) of the Social Security Act, as amended by the Social Security Protection Act of 2004 (Pub. L. No. 108-203). We need this information to efficiently process this Internet request. Giving us these facts is voluntary. However, without them, we may not be able to process your application online. Social Security may provide information collected on this application to the Internal Revenue Service.

Paperwork Reduction Act Statement

This information collection meets the requirements of 44 U.S.C. § 3507, as amended by § 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 20 minutes to read the instructions, gather the facts, and answer the questions. You may send comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address, not the completed form.