The following subsection provides models of the acknowledgment letters described in GN 03950.030. Dictated letters must be prepared using these model letters as guides.

AF-1 — Acknowledgment Letter - No Development (To Claimant)

 

James Smith

Street Address

City/State/ZIP Code

 

We are writing about your letter dated January 25, 1995. You asked us to lower the fee amount we said your representative can charge for work on your claim.

 

Because you asked us to review the fee amount, we are giving you a list of rules we use to decide a fee. When we approve a representative's fee, we consider the purpose of the Social Security and Supplemental Security Income (SSI) programs. In all cases, we also consider:

• •

  the services provided (including the type of service);

• •

  the difficulty of the case;

• •

  the level of skill required to provide the services;

• •

  the amount of time spent on the case;

• •

  the results achieved;

• •

  the level of administrative review to which the representative took the claim;

• •

  the level of review at which the representative entered the proceedings; and

• •

  the fee amount requested, not including any out-of-pocket expenses but including any amount already approved or requested. An example of out-of-pocket expenses is the cost to get copies of doctors' and hospitals' reports.

   

What Will Happen

 

Someone who did not decide the fee amount will review the decision and make a new one. Based on that review we will raise, lower, or not change the fee amount your representative can charge.

 

Because John Jones, Susy Smith, and Joey Smith can comment on your request for administrative review, we are sending them a copy of your request. They also can provide more information to the person reviewing your request.

 

If we need more information, we will contact you. We will send you, and the other people listed above, a letter telling what we decide.

 

If You Have Any Questions

 

If you have questions about this letter, please write us at:

 

Address of Originating Component

 

If you have questions about other Social Security matters, call us toll free at 1-800-772-1213, 7 a.m. to 7 p.m. Monday through Friday. We can answer most questions over the phone. Our busiest times are the first week of the month and Mondays. So, we may be able to handle your call more quickly if you can call us at other times.

 

If you wish, you can call your local Social Security office at xxx-xxxx. You can also write or visit a Social Security office. The office that serves your area is located at:

 

•  

  Street Address
  
  City/State/Zip Code

   

If you do call or visit an office, please have this letter with you. It will help us answer your questions. This will help us serve you more quickly.

 

AF-2 — Acknowledgment Letter - No Development (To Representative)

 

Jane Doe

[Attorney at Law]

Street Address

City/State/ZIP Code

 

We are writing about your letter dated January 25, 1995. You asked us to raise the fee amount we said you can charge for your work on Sally Brown's claim. You also said the claimant has not paid the fee.

 

What Will Happen

 

Someone who did not decide the fee amount will review the decision and make a new one. Based on that review we will raise, lower, or not change the amount of the fee you can charge. We will pay you as much of the fee as the law allows.

 

Because Sally Brown, Susy Brown, and Joey Brown can comment on your request for administrative review, we are sending them a copy of this letter. They also can provide more information to the person reviewing your request.

 

If we need more information, we will contact you. We will send you and the other people listed above a letter telling what we decide.

 

If You Have Any Questions

 

See Referral Paragraphs in Model Acknowledgment Letter AF-1

 

AF-3 — Acknowledgment Letter - No Development (To Nonrequester)

 

Sally Brown

Street Address

City/State/ZIP Code

 

Jane Doe has asked us to raise the fee amount we said they can charge for work on your claim.

 

What Will Happen

 

Someone who did not decide the fee amount will review the decision and make a new one. Based on that review we will raise, lower, or not change the fee amount your representative can charge.

 

Your representative also said that you had not paid the fee. Since you haven't paid, we will pay your representative as much of the fee as the law allows. Then we plan to take this amount out of your future benefits. You will get another letter about this.

 

What You Can Do

 

We are sending you a copy of Jane Doe's letter. If you have comments about the letter or want to give us more information, write us within 15 days. We will consider what you tell us. You can write us at this address:

 

Address of Originating Component

 

If You Have Any Questions

 

If you have questions about this letter, please write us at the above address.

 

If you have questions about other Social Security matters, call us toll free at 1-800-772-1213, 7 a.m. to 7 p.m. Monday through Friday. We can answer most questions over the phone. Our busiest times are the first week of the month and Mondays. So, we may be able to handle your call more quickly if you can call us at other times.

 

If you wish, you can call your local Social Security office at xxx-xxxx. You can also write or visit a Social Security office. The office that serves your area is located at:

 

•  

  Street Address
  
  City/State/Zip Code

   

If you do call or visit an office, please have this letter with you. It will help us answer your questions. This will help us serve you more quickly.

 

AF-4 — Acknowledging Receipt of Request for Administrative Review Received by Wrong Office - Forwarded to Correct Office

 

Abbey Rhodes

[Attorney at Law]

Street Address

City/State/ZIP Code

 

We are writing about your letter postmarked May 18, 1995. You asked us to raise the fee amount we said you can charge for your work on George Harrison's claim.

 

What We Have Done

 

We have sent your letter to the Office of Central Operations, 6401 Secuirty Boulevard, Baltimore, MD 21235. Someone in that office will review your request. If you want more information or have questions about the review, please write to that office.