SSA - POMS: GN 03960.065 - Post-Review Actions Under the Fee Agreement Process - Title XVI

1. Review of the Fee Agreement Determination

Post-review actions vary according to the reviewer's determination on administrative review.

a. Reviewer Affirmed the Disapproval

When the reviewer has affirmed the disapproval of the fee agreement, the representative must seek approval under the fee petition process to charge and collect a fee. The processing center (PC) reviewer will ensure a copy of the administrative review determination is associated with the claim(s) file and added to Evidence Portal (EP). The PC reviewer will notify the field office (FO) using the Processing Center Action Control System (PCACS), or other locally acceptable method, of their action and that the disapproval notice is available in the claim file(s).

b. Reviewer Affirmed the Approval or Approved the Fee Agreement

When the reviewer has reversed the initial determination and approved the fee agreement, or affirmed the initial approval, the following occurs.

The PC reviewer ensures a copy of the determination is associated with the claim(s) file and EP. They will then notify the FO via PCACS, or other locally acceptable method, of their action, that the approval notice is available in the claim file(s), and take the actions in GN 03960.065A.1.b.

The FO claims specialist (CS) follows GN 03940.046 to determine the fee amount and, in concurrent cases, SI 02006.210 to adjust the Title II income when the FO receives a copy of the claimant's notice showing the Title II portion of the fee amount.

The FO CS also provides notice of the amount of the fee under the approved agreement and, if not done already, the past-due benefits amount.

2. Reviewer First to Disapprove the Fee Agreement

When the requester disagreed with the amount of the fee under the agreement and the reviewer disapproved the fee agreement on administrative review, the representative must seek authorization under the fee petition process to charge and collect a fee.

a. PC Reviewer Actions

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When the representative submitted a Form SSA-1560 or an equivalent fee petition statement in connection with the request, the PC reviewer sends the material to the individual in the PC delegated the authority to authorize the representative's fee under the fee petition process (see GN 03930.015). If the initial authorization was made at hearing level or above, the reviewer will forward the Form SSA-1560 or equivalent fee petition to the appropriate decision maker identified in GN 03930.015B.
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When the representative has not submitted a Form SSA-1560 or equivalent fee petition statement, the PC reviewer ensures a copy of the determination is associated with the claim(s) file or EP and will notify the FO using PCACS or other locally acceptable method, of their action, that the disapproval notice is available in the claim file(s) or EP, and to follow the procedures outlined in GN 03960.065A.2.b.

b. FO Action When the Reviewer Disapproved the Fee Agreement

When the reviewer disapproved the fee agreement:

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Determine if post-review action is necessary concerning any Title XVI portion of the representative's fee.
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If the FO adjusted the Title II income (following SI 00830.100 and SI 02006.210) but the claimant has not paid the amount of the fee authorized under the agreement, the FO CS readjusts the Title II income to reflect that the claimant has not incurred expenses for representation.
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If the FO did not adjust the Title II income or if the claimant has paid the amount of the fee authorized under the agreement, no post-review action is necessary concerning the Title II portion of the representative's fee.

NOTE 1: Adjustment may later be necessary if we subsequently authorize a fee under the fee petition process or the representative or entity refunds the fee amount paid by the claimant under the fee agreement.

NOTE 2: If the representative timely submits a complete fee petition or written notice of their intent to file a petition (see GN 03930.030D), any fee previously authorized and directly paid will be treated as a payment from another source when releasing past-due benefits (see GN 03930.060D) or as an excess fee matter (see GN 03920.051) depending on the circumstances. If the representative does not timely file their fee petition or written notice of intent, the previously authorized and paid fee becomes an excess fee matter.

3. Reviewer Affirms the Fee Under the Agreement

When the reviewer has affirmed the amount of the fee authorized under the agreement, the following occurs:

a.

PC Reviewer Actions

The PC reviewer will ensure a copy of the determination is associated with the claim(s) file or EP and will notify the FO using PCACS or other locally acceptable method, of their action, that the disapproval notice is available in the claim file(s) and to follow the procedures outlined in GN 03960.065A.3.b.
b.
FO Action When the Reviewer Affirmed the Fee for Services
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  Determine if post-review action is necessary concerning the Title XVI portion of the representative's fee.
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  If the FO adjusted the Title II income (following SI 00830.100 and SI 02006.210), no post-review action is necessary.
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  If the FO did not adjust the Title II income, the FO CS follows SI 00830.100 and SI 02006.210 and adjusts the Title II income to reflect the amount of the fee for both the Titles II and XVI claims.

4. Reviewer Modifies the Fee Under the Agreement

When the reviewer has modified the amount of the fee authorized under the agreement, the following occurs:

a.

PC Reviewer Actions

The PC reviewer ensures a copy of the determination is associated with the claim(s) file or EP and notifies the FO using PCACS or other locally acceptable method, of their action, that the disapproval notice is available in the claim file(s) or EP, and to follow the procedures outlined in GN 03960.065A.4.b.
b.
FO Action When the Reviewer Modified the Fee for Services
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  Determine if post-review action is necessary concerning any Title XVI portion of the representative's fee.
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  The FO CS follows SI 00830.100 and SI 02006.210 and adjusts the Title II income to reflect the amount of the fee for both the Titles II and XVI claims.

Social Security

Program Operations Manual System (POMS)

GN 03960.065 Post-Review Actions Under the Fee Agreement Process - Title XVI

A. Process