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Description of form 1696
Form SSA-1696-U4 03-2011 ef 03-2011 Destroy Prior Editions Information from these matching programs can be used to establish or verify a person s eligibility for Federally-funded or administered benefit programs and for repayment of payments or delinquent debts under these programs. If you will have more than one representative check the appropriate block and give the name of the individual you want to be your main representative. You must sign and date the form. Print or type your address area code and telephone number. If you are appointing a representative to replace a or her representation you must notify us in writing that the prior appointment has ended. Part II Acceptance of Appointment Each individual you appoint in Part I should...
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form 1696
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