Every notice of the determination following administrative review must include the following:

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  The authority under which the administrative review was conducted,

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  The fee evaluation criteria used,

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  An explanation of how the services were evaluated considering the seven evaluation factors (GN 03930.010),

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  A statement of whether the amount of the initial fee was affirmed or modified and the reviewer's reasons for their action,

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  The amount of the fee authorized on review,

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  Responses to all issues raised during the administrative review or a statement that the issue(s) is being considered and will be addressed at a later date (e.g., we failed to certify direct payment to an eligible representative or entity of the initial authorized fee because we did not withhold past-due benefits or prematurely released them),

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  A discussion of the method of payment of the representative's fee (e.g., we will certify direct payment of all or a portion of the fee to the eligible representative or entity, if there is a valid assignment; the claimant is responsible for payment of all or a portion of the representative's fee). However, if we previously released the remaining withheld past-due benefits after paying an eligible representative or entity the initial authorized fee, advise the eligible representative to contact us if they are unable to collect the increased fee from the claimant. The representative must refund to the claimant and any affected auxiliary beneficiary or eligible spouse, if appropriate, any excess amount previously certified or paid,

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  A statement that the Act and regulations do not provide for further review of the administrative review determination,

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  A statement that all of the other parties (by name) will receive a copy of the administrative review determination letter, and

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  A referral paragraph that includes the address and local telephone number of the servicing FO as well as "800" number information.

Model notices that explain the process of administrative review are contained in GN 03950.065. They must, however, be modified to fit the specific circumstances presented in each case. Representatives generally have multiple cases before us, and each case is different. Sending stock notices, without individualized rationales, would give the appearance of a pro forma review, and could jeopardize the integrity of the process of administrative review.

Because of Privacy Act considerations, we will not reveal:

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  The claimant's personal information (e.g., mailing address or Social Security number) when sending a copy of a letter addressed to the claimant, or the claimant's request for administrative review, to a party other than an individual representative; or

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  The auxiliary beneficiary's personal information when sending a copy of a letter addressed to the beneficiary, or the beneficiary's request for administrative review, to a party other than an individual representative.

  NOTE: Representatives are bound by the regulations not to disclose any information we furnish or disclose about the claim or prospective claim of another person without that person’s consent except as may be authorized by regulations prescribed by us, or otherwise provided by Federal law (see 20 CFR 404.1740(d) and 416.1520(d)).

This restriction means we must redact any personal information before mailing.

Prepare notices as follows:

1. a. 

   In the opening paragraph, state the authority under which you are conducting administrative review. If applicable, indicate the basis for review (e.g., error of fact, error of law, or new information).

2. b. 

   In the second paragraph, if the above basis for review exists, state the fee evaluation criteria you used in reviewing the initial fee authorization. This statement is not necessary if you informed the parties of these criteria in the acknowledgment or interim letters.

3. c. 

   In the next paragraph, if the above basis for review exists, state how you evaluated the services in light of the seven regulatory factors (GN 03930.010), but focus in detail on:

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     The number of hours considered;

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     The value of the services to the case;

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     What services were exceptional, and why;

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     What services were not considered, and why;

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     Any services whose value you have questioned, and why; and

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     Any services where you questioned the amount of time spent, and why.

4. d. 

   In the next paragraph, state whether you are affirming or modifying the initial fee and why. If you are modifying the fee, also state the dollar amount of the fee authorized on administrative review.

5. e. 

   In the next paragraph, state your resolution of the issue(s) raised and the method of payment to the representative or entity if there is a valid assignment..

6. f. 

   In the last portion of the notice state that your determination is not subject to further review (citing 20 CFR 404.1720(d)(1) and/or 416.1520(d)(1)) and that you are mailing copies of the notice to all other parties.