1. a. 

   In reviewing the fee agreement determination consider if:

   • •

     The conditions for approving the fee agreement were met at the time the decision maker made the favorable determination on the claim or post-entitlement/post-eligibility (PE) action (GN 03940.003B lists the conditions); or

   • •

     Any of the exceptions to the fee agreement process applied at the time the decision maker made the favorable determination on the claim or PE action or, if later, acted on the agreement (GN 03940.001C.2. lists the exceptions or exclusions).

   NOTE: Generally, the decision maker approves or disapproves a fee agreement when making the determination favorable to the claimant. However, sometimes the decision maker considers the fee agreement at a later time, e.g., if the fee agreement filed with us is not referred to the decision maker before they favorably decide the claim.

2. b. 

   Either affirm the approval or reverse the previous disapproval determination and approve the fee agreement if:

   • •

     The fee agreement met all the conditions for approval; and

   • •

     None of the exceptions applied at the time the decision maker made the favorable determination on the claim or PE action or, if later, approved or disapproved the agreement.

3. c. 

   Either affirm the disapproval or reverse the previous approval determination and disapprove the fee agreement if:

   • •

     The fee agreement did not meet all the conditions for approval; or

   • •

     One or more exceptions applied at the time the decision maker made the favorable determination on the claim or PE action or, if later, approved or disapproved the agreement.

   EXAMPLES:

   • •

     The decision maker disapproved a fee agreement because it was not signed by the representative. The representative requested review of the disapproval and submitted a signed fee agreement to correct the omission. The reviewer must affirm the disapproval because the fee agreement did not meet the signature requirement when the decision maker favorably decided the claim.

   • •

     The representative filed the fee agreement signed by the representative and the claimant with one of our offices on January 7. The decision maker, in another office, made a favorable determination on January 13. On January 17, the claimant was declared legally incompetent by a state court. Subsequently, the decision maker received and disapproved the fee agreement. The reviewer must reverse the disapproval. The fee agreement met all the statutory conditions for approval and none of the exceptions applied when the decision maker favorably decided the claim. Although the claimant had been declared legally incompetent, it was not before the claimant signed the fee agreement (see GN 03940.003D.4).

To issue a notice of the determination on administrative review:

1. a. 

   Follow GN 03960.070 to prepare the letter to the requester, consistent with the following instructions in GN 03960.037 B.2.b through g., for release with the signature of the Assistant Regional Commissioner for Processing Center Operations (ARC-PCO) in the Program Service Centers (PSC); or the Director of the Office of Central Operations or a designee in a non-PSC cases. Refer to GN 03960.085 for model letters.

2. b. 

   Include a brief explanation of your good cause finding, if the requester did not file timely and you did not resolve the issue in your acknowledgment or interim letter(s).

3. c. 

   Respond to the issue(s) raised.

4. d. 

   If you have affirmed the disapproval or reversed the previous determination and disapproved the fee agreement:

   • •

     Explain both your action and that the representative must request approval of any fee they want to charge and collect using the fee petition process.

   • •

     Enclose an SSA-1560 with the letter or copy sent to the representative.

   • •

     In a Title II case involving a representative eligible for direct payment, follow GN 03930.090 when more than 60 days have elapsed since we first advised the eligible representative of the need to request fee approval under the fee petition process. This will advise the claimant and eligible representative that to receive direct payment from past-due benefits withheld, the representative must file a written request for approval of a fee or an extension of time to file the request within 20 days.

     NOTE: In limited circumstance, the POC may file the fee petition (see GN 03930.020A). If there is a valid assignment, and we have information confirming the limited circumstances exist, send a copy of this 20-day notice to the eligible entity’s point of contact (POC). For information about the assignment of direct payment of fees, including the roles and responsibilities of a POC, see GN 03920.021.

   • •

     Proceed to GN 03960.035B.2.f.

5. e. 

   If you have reversed the disapproval, explain why you now approve the fee agreement. In authorizing the fee, you must also include an explanation of the procedure for review of the fee resulting from the agreement. If you affirmed the previous approval, state that you are affirming the initial fee agreement determination.

   • •

     In a Title II case, depending on whether you know the past-due benefits amount, include either the amount of the fee under the agreement or a statement that we will authorize the fee when past-due benefits are determined.

   • •

     In a Title XVI case, state that we will authorize the fee when past-due benefits are determined.

6. f. 

   State that you are sending copies of the determination to the party or parties named and the decision maker.

7. g. 

   State that the fee agreement determination is not subject to further review.

8. h. 

   Send copies of the determination to any other party and the decision maker (or an email to notify the decision maker that the determination is available in the Online Retrieval System (ORS)), as GN 03960.030B. requires.

9. i. 

   See GN 03960.060 in a Title II case, or GN 03960.065.1. in a Title XVI case, or both, for subsequent actions which vary depending on the result.