GN 03960.055 Processing Center Reviewer Responsibilities - Beginning Administrative Review of the Fee Authorized Under the Fee Agreement Process

A. Introduction

After any necessary preliminary actions in GN 03960.015 are complete and you received the request for review, begin administrative review.

Follow the instructions in subchapter GN 03950.000 when we authorized a fee under the fee petition process in GN 03950.001.

B. Procedure

If we authorized a fee under the fee agreement process, follow the steps below when reviewing a determination made about the fee authorized under the agreement.

1. Establish Authority to Review

Confirm that you have authority to act on the request for administrative review. See GN 03960.005 for jurisdiction.

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If you do not have authority, follow the instructions in GN 03960.015B to refer the request to the correct office. Do not proceed furhter in this section.
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If you do have authority, obtain the claim(s) file, if needed, or ensure you have access to the electronic record.

2. Examine the Claim(s) File and the Request

a.
Examine the claim(s) file and the request for administrative review. Identify:
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  All parties;
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  The fee agreement;
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  The SSA-553(Special Determination), or another document listed in GN 03960.001A.7, documenting the determination;
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  The notice of the fee determination;
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  Any funds the representative may hold in a trust or escrow account;
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  Any failure to withhold, or premature release of, past-due benefits; and
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  Whether the case involves concurrent Titles II and XVI claims or affected auxiliary beneficiaries (see GN 03960.043.).
b.
Screen the request for administrative review for:
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  Timely filing;
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  Filing by a proper party; and
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  The need for action on any other issue(s) the requester raised.
c.

Initiate any necessary development by telephone, after confirming the identity of the speaker, or include your request for additional information in the acknowledgment letter. Ask for a response within 15 days and diary the case for 30 days.
d.

Proceed to GN 03960.055B.3 or GN 03960.055B.4.

NOTE: An entity is not a party to a fee agreement even where a representative validly assigned direct payment of a fee to that entity. As such, the entity and its POC generally do not have the right to file for administrative review and only the assigning representative has the right to request administrative review. However, if a representative who has validly assigned direct payment of any authorized fees dies, and at least one other representative seeking a fee remains active on the claim (see GN 03940.003D6), or the representative died after the agreement was approved and an initial fee was authorized, the entity’s POC may request administrative review under the fee agreement process. For more information about the assignment of direct payment fees, including the roles and responsibilities of POCs, see GN 03920.021.

3. Act on Late Filing with No Good Cause or Filing by Improper Party

a.
If any of the following situtaions apply, proceed to GN 03960.055B.3.b.
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  A decision maker did not file timely, and you do not find good cause for late filing based on information the decision maker submitted with the request for administrative review.
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  A claimant, auxiliary beneficiary, eligible spouse, or representative did not file timely, and you do not find good cause for late filing based on the explanation given. See GN 03960.025B.2 for examples of good cause.
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  An improper party requested administrative review.
b.

Follow GN 03960.070 to prepare the letter described below. Refer to GN 03960.085 for model letters.
c.
Send a letter telling the requester:
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  The reason(s) for deciding that the requester did not establish good cause, or that the requester is not a proper party;
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  You will not review the determination; and
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  The previous determination of the amount the representative may charge for the representative's work in the case is final.
d.

Send copies to the other parties. Because of Privacy Act considerations, ensure that the mailing address of the claimant, any auxiliary beneficiary, or eligible spouse is redacted from the copy of the notice sent to any other party (the proper parties described in GN 03960.001B.10) except the representative(s).
e.

Do not proceed with administrative review.

4. Consider the Approval of the Fee Agreement

a.

If disapproval of the fee agreement has been addressed previously on a request for administrative review, proceed to GN 03960.055B.5.
b.
Otherwise, consider whether the decision maker's approval of the agreement was correct, following GN 03960.040C.1.
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  If the approval was correct, proceed to GN 03960.055B.5.
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  If not, prepare a brief explanation of why you plan to disapprove the fee agreement and note that if you do so, the representative must ask in writing for our approval of the amount of the fee the representative wants to charge using a fee petition. However, if the representative already submitted a form SSA-1560 or equivalent statement in connection with the request for administrative review of the amount of the fee, advise the representative that upon completion of our action we will consider such material under the fee petition process. Include this information in the letters described in GN 03960.055B.7, acknowledging receipt and notifying the other parties of the request for administrative review. Proceed to GN 03960.055B.7.

5. Check the Fee Amount Under the Terms of the Agreement

Proceed to GN 03960.055B.6 or GN 03960.055B.7 when:

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No party has disagreed with the calculation; and
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There is no apparent error considering the statutory limit described in GN 03940.003B.3, the percentage specified in the agreement, and any other terms in the fee agreement.

Otherwise, follow GN 03960.040C.2.c or d and if necessary, GN 03960.045 and GN 03960.047 about recalculation.

If we revise our determination or decision about the amount of past-due benefits, follow GN 03960.045C. or GN 03960.047C.2. and curtail your review.

Otherwise, proceed to GN 03960.055B.6 or GN 03960.055B.7..

6. Consider the Standard a Decision Maker Must Meet

Consider the standard in GN 03960.040C.3.

a.

If you find evidence showing that either the representative did not represent the claimant's interest adequately or the fee is clearly excessive considering the services provided, proceed to GN 03960.055B.7.
b.
If you do not find evidence suggesting inadequate representation or a clearly excessive fee, take the following actions:
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  Follow GN 03960.070 to prepare the letter described in the following bullet. Refer to GN 03960.085 for model letters.
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  If there is no apparent clerical error involved (see GN 03960.040C.2), send a letter telling the decision maker that you did not find evidence of inadequate representation or a clearly excessive fee; that you will not review the determination further; and that the previous determination of the amount the representative may charge and collect for the representative's work in the case is final.
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  If there is an apparent clerical error involved, send a letter telling the decision maker that you did not find evidence of inadequate representation or a clearly excessive fee; that you will not review the determination further; and that you are notifying the effectuating component(s) that an apparent clerical error has been made and that you request that it release a corrective notice(s) that includes new administrative review rights.
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  Send copies to the other parties. Because of Privacy Act considerations, ensure that the mailing address of the claimant, any auxiliary beneficiary, or eligible spouse is redacted from the copy of the notice sent to any other party (the proper parties described in GN 03960.001B.10) except the representative(s).
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  Do not proceed with administrative review. In the case of clerical error, notify the effectuating component(s) of the need for corrective action.

7. Provide Notice Acknowledging Receipt

Follow GN 03960.070 to prepare the following letters. Because of Privacy Act considerations, ensure that the mailing address of the claimant, any auxiliary beneficiary, or eligible spouse is redacted from the copy of the notice sent to any other party (the proper parties described in GN 03960.001B.10) except the representative(s).

Refer to GN 03960.075 for model letters.

a.
Prepare the letter telling the requester that you:
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  Received the request;
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  Are notifying the other parties; and
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  Will give them the opportunity to comment or submit additional information.
Also advise the requester of any outstanding issues, such as:
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  Untimely filing of the request for administrative review;
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  Improperly approved fee agreement; or
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  Incorrectly calculated fee amount.
b.

Prepare letters informing any other party of the request for administrative review and what happens next. Advise any party of any outstanding issues, such as those outlined above, and give them the opportunity to comment or submit additional information.
c.

Enclose a copy of the request for administrative review with each letter to the other parties. Because of Privacy Act considerations, ensure that the mailing address of the claimant, any auxiliary beneficiary, or eligible spouse is redacted from the copy of the notice sent to any other party (the proper parties described in GN 03960.001B.10) except the representative(s).
d.

Send the letters and enclosures. Diary the case for 30 days.
e.
When the diary matures, proceed to:
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  GN 03960.057B.1 and 3, if you proposed to disapprove the fee agreement following the instructions in GN 03960.005B.4.b and disapproval is proper;
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  GN 03960.057B.1. and 3., if GN 03960.040C.2.c. applies and you are modifying an incorrectly calculated fee amount;
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  GN 03960.055B.8 if you are ready to act on the requester's explanation for late filing;
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  GN 03960.055B.9 if you need to follow-up for information you requested; or
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  GN 03960.057, if the requester filed timely or you already decided the requester had shown good cause for late filing and none of the above applies.

8. Provide Subsequent Notice - Good Cause Question

Follow GN 03960.070 to prepare the letter(s) described in GN 03960.055B.8.a or GN 03960.055B.8.b. Because of Privacy Act considerations, ensure that the mailing address of the claimant, any auxiliary beneficiary, or eligible spouse is redacted from the copy of the notice sent to any other party (the proper parties described in GN 03960.001B.10) except the representative(s). Refer to GN 03960.080 for model letters.

a.

If the requester did not file timely and you received an explanation but have not decided the good cause question (in order to obtain further input as noted in GN 03960.025A.2.b), prepare letters informing any other party of the requester's explanation for late filing; that they may comment in writing and submit relevant information within 15 days; and that they will hear from you after you have decided whether the requester has established good cause. Proceed to GN 03960.055B.8.c.
b.

Decide whether the requester has established good cause for late filing, if ready. See GN 03960.025B.2 for examples of good cause.

If the requester has not established good cause, go back to GN 03960.055B.3.

If the requester has shown good cause, prepare letters to the requester and any other party briefly explaining your finding; what happens on review; and that they may comment in writing and submit relevant information within 15 days.

If you plan to disapprove the fee agreement, include the explanation described above in GN 03960.055B.4.b.

If you do not plan to disapprove the fee agreement, include an explanation of the correct fee amount, if we incorrectly calculated the amount of the fee under the fee agreement; and, if GN 03960.040C.2.c applies, that you will modify the amount of the fee if neither the requester nor any other party objects to the proposed modification during the comment period; or, if GN 03960.040C.2.d. applies, explain that you will consider the corrected fee amount when determining whether the fee is reasonable.

If you expect to evaluate the representative's services (considering GN 03960.040C.2.d.960.040C.2.d and GN 03960.050), include the request described in GN 03960.050D.2 in the letter you prepare for the representative.
c.

Send the letters. Diary the case for 30 days.
d.
When the diary matures:
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  Return to GN 03960.055B.8.b, if you have not yet decided the good cause question;
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  Return to GN 03960.055B.3, if the requester has not established good cause for late filing;
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  Proceed to GN 03960.055B.9, if you need to follow-up for information you requested; or
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  Proceed to GN 03960.057, if you are ready to complete administrative review.

9. Follow-up for Outstanding Information

a.

Follow-up once by telephone or mail for any additional information you requested but have not received. Advise the party that if you do not receive it within 15 days, you will make a determination on the request for administrative review based on the information in file.
b.

Diary the case for 30 days.
c.
When you receive the information or the diary matures:
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  Return to GN 03960.055B.3, if the requester has not shown good cause for late filing;
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  Return to GN 03960.055B.8, if you are ready to act on the requester's explanation for late filing; or
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  Proceed to GN 03960.057, if you are ready to complete administrative review.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203960055

GN 03960.055 - Processing Center Reviewer Responsibilities - Beginning Administrative Review of the Fee Authorized Under the Fee Agreement Process - 12/09/2024
Batch run: 12/19/2024
Rev:12/09/2024

Social Security

Program Operations Manual System (POMS)