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Charles L. Brieant Jr. Federal Building and Courthouse 300 Quarropas Street White Plains, NY 10601. To be appointed as the applicant's representative, the case manager must complete the SSA-1696: Appointment of Representative form.Use this form to change information related to the owner, attorney, or representative. Completion of this form is voluntary; however, if you want to use this form to appoint someone to act on your behalf in matters before the Social Security. License Application. Application For Sales Representative- Lt-426 ; Duration of License. Checklist: Get Prepared for the Loan Process. Subject to certain exceptions, the Privacy Rule at 45 CFR 164. Print and complete the Appointment of Representative form below. Subject to certain exceptions, the Privacy Rule at 45 CFR 164.