Form Ssa-1699 - Registration For Appointed Representative Services And Direct Payment Page 4
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8Section II: Your Representational Standing
Check one of the boxes below.
Are you currently in good standing and admitted to practice law before the U.S. Supreme Court; a U.S. Federal, state, territorial,
insular possession, or District of Columbia court; or a member of a state bar if that membership carries with it the authority to
practice law in that state?
Yes
(Go to Section III)
No (Go to Section IV)
NOTE: If you are not in the business of providing services to Social Security claimants and beneficiaries, but will be appointed as
a representative for a relative, friend, or other acquaintance, YOU DO NOT NEED TO COMPLETE THIS FORM.
Section III: Your Bar and Court Information
Provide information for one state, U.S. territory, or U.S. Federal Court in which you currently are in good standing and have the
right to practice law.
Year
Court or Bar License Number
Court or Bar
Admitted
(If one issued)
(YYYY)
Form SSA-1699 (09-2013)
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