Current SSA-1694

Form SSA-1694 (09-2022)
Discontinue Prior Editions
Social Security Administration

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OMB No. 0960-0731

Request for Business Entity Taxpayer Information
BUSINESS INFORMATION
Employer Identification Number (EIN)

Name of the Business Entity

Tax Mailing Address
P.O. Box, Street, Apt., or Suite No.

City

State

ZIP Code or Postal Zone

Country

PERJURY STATEMENT
I declare under penalty of perjury that I have examined all of the information on this request and it is true to the best of
my knowledge. I am aware that if I knowingly and willingly make any false representation about any material fact
provided herein or knowingly and willingly make any false representation to obtain information from Social Security
records, and/or attempt to deceive the Social Security Administration as to my true identity, I could be criminally
punished by a fine or imprisonment or both.
Printed Name

Signature

Date
/

Contact Name

FOR AGENCY USE ONLY:

/

Phone Number (including area code)

Form SSA-1694 (09-2022)

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IMPORTANT INFORMATION
Purpose of Form
The Social Security Administration (SSA) is required to file an information return (i.e., Form 1099-MISC) with the Internal
Revenue Service (IRS) when payments of $600 or more have been made to appointed representatives associated with a
business entity as employees or partners. In order to meet this requirement, SSA must obtain the name, employer identification
number (EIN), and address of the business entity.

Instructions for Completing the Form
Employer Identification Number
Please enter your EIN. If you do not have an EIN, please apply for one immediately by filing an SS-4, Application for Employer
Identification Number, with the IRS. You can apply for an EIN online by accessing the IRS website at www.irs.gov.

Name of Business Entity
Enter your business name as shown on required Federal tax documents. Normally, this will match the name used when you filed
a Form SS-4 to apply for an EIN.

Tax Mailing Address
Please enter your tax mailing address. SSA will mail Form 1099-MISC to you at this address if payments of $600 or more are
made to appointed representatives associated with your business entity during a tax year.

Privacy Act Statement
Collection and Use of Personal Information
Sections 206(a) and 1631(d) of the Social Security Act, as amended, allows us to collect this information. Furnishing us this
information is voluntary. However, failing to provide all or part of the information may prevent you from serving as an appointed
representative and receiving direct payment of fees from SSA.
We will use the information to identify appointed representatives associated with a business entity as employees or partners, and
to facilitate issuance of appropriate return information for reporting purposes. We may also share your information for the
following purposes, called routine uses:
• To employers of claimants’ representatives (e.g., law firms, partnerships, or other business entities) in accordance with
the requirements of sections 6041 and 6045(f) of the IRC as implemented by the IRS Regulations found at 26 CFR
1.6041-1, and as necessary for us to carry out the requirements for fee reporting to appointed representatives; and
• To contractors and other Federal agencies, as necessary, to assist us in efficiently administering our programs. We will
disclose information under this routine use only in situations in which we may enter into a contractual or similar
agreement with a third party to assist in accomplishing an agency function relating to this system of records.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where
authorized, we may use and disclose this information in computer matching programs, in which our records are compared with
other records to establish or verify a person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent
debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0325, entitled Appointed
Representative File, as published in the Federal Register (FR) on October 8, 2009, at 74 FR 51940. Additional information, and a
full listing of all our SORNs, is available on our website at www.ssa.gov/privacy.

Paperwork Reduction Act Statement
This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 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 (OMB) control number. We estimate that it will take about 20 minutes to read the instructions, gather the facts, and
answer the questions. Send only comments regarding this burden estimate or any other aspect of this collection,
including suggestions for reducing this burden to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.