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Form SSA 1696 Appointing a Representative
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Form SSA 1696 Appointing a Representative

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Print or type your address, area code and telephone number. To enable a third party or an agency to assist social security in establishing rights to social security benefits and/or coverage; To comply with federal laws requiring the. Government agencies in your telephone directory or you may call social.

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The claimant’s data (name, ssn, address, phone number) the wage. You must sign and date the form. Complete, sign, and date the section. Instructions for completing form (policy research associates) form.

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