CMS-1696: a family walkthrough
If you're appealing on behalf of a parent or another family member, CMS-1696 (Appointment of Representative) is the form that lets you act as the main contact for the appeal — make requests, present evidence, get information, and receive all communication about it.CMS
It's a short, two-section form, and most families fill it out in a few minutes. Here's what each part actually asks for, and the questions that come up most — who's allowed to sign, whether a power of attorney already covers this, and how long it lasts.
Who can sign it
The form asks for the representative's "professional status or relationship to the person" being represented — an attorney, a relative, or anyone else the beneficiary chooses. It isn't limited to lawyers.CMS
Both people have to sign: the person being represented (or whoever is completing Section 1 on their behalf) and the representative. A form signed by only one side isn't complete.CMS
This person becomes the main point of contact for the appeal and can see personal medical information related to it — the same access the beneficiary themselves would have. That's a real responsibility, not just a formality, which is part of why both signatures are required.
A general power of attorney isn't the same thing
A power of attorney for finances or healthcare decisions doesn't automatically make someone your Medicare appeals representative. CMS has its own specific form for this exact purpose — that's what plans and reviewers expect to see attached to an appeal.
Sending a general POA document instead of CMS-1696 usually just slows things down — the plan or reviewer still needs the specific appointment this form establishes before they'll talk to anyone but the beneficiary directly.
How long it's valid
An appointment is valid for one year from the date both people sign it, and can be used for other appeals or actions during that year. Once filed with a specific appeal, it stays valid for that appeal's entire duration unless revoked — it doesn't need to be resigned at every level.CMS
That means one signed form, filed once, can carry a case from the first-level reconsideration all the way through an ALJ hearing, even if that whole process takes well over a year.
Notarization isn't required
The form has no notary field and no witness requirement — just the two signatures described above.CMS
That's a real, common source of confusion, since plenty of authorization forms families deal with elsewhere do require notarization. This one specifically doesn't.
Fees
A provider or supplier who furnished the service being appealed can represent the patient, but can't charge a fee for doing so. An attorney or other paid representative who wants to charge a fee for representing you at an ALJ hearing or higher has to get that fee approved — it isn't automatic.CMS
For a family member representing a parent or spouse, none of this applies — the fee-approval process only matters when the representative is being paid.
Questions people ask
- Do I need a lawyer to fill this out?
- No. The form itself asks for "relationship to the person" as an option alongside attorney — a son, daughter, or other family member can be the representative.
- Does it expire in the middle of an appeal?
- No — once it's filed with a specific appeal, it covers that appeal for its full duration, even if that takes longer than a year, unless it's revoked.
Sources
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By CaseWhy Appeals editorial. See how this content is produced. Not legal advice. Not affiliated with or endorsed by Medicare, CMS, or any health plan. A product of CaseWhy LLC.
