Basic (12-19)

GN 03905.065 Exhibits for Fee Authorization under the Fee Agreement Process

A. When to use

We use these templates in the fee authorization process either to authorize the fee or to contact the hearing or Appeals Council offices when further actions on fee agreement determinations are necessary.

B. Exhibits

1. Sample Language for Fee Agreement Determination (Form SSA-553 Special Determination)

I. FEE AGREEMENT APPROVED:

I approve the fee agreement between the claimant and his or her representative provided that the claim results in past-due benefits.

My determination is limited to whether the fee agreement meets the statutory condition for approval and is not otherwise excepted.

I neither approve nor disapprove any other aspect of the fee agreement.

II. FEE AGREEMENT DISAPPROVED:

I do not approve the fee agreement between the claimant and his or her representative because:

[Check only those that apply]

____SSA did not receive the written agreement before deciding the claim.
____The claimant and his or her representative(s) all did not sign the fee agreement.
____The fee agreement sets a fee that is more than the lesser of 25 percent of the past-due benefits or the applicable specified dollar amount of the fee cap as outlined in GN 03940.003B.3 (e.g., $6,000).
____The claimant appointed more than one representative, all did not sign a single fee agreement, and the non-signing representative(s) did not waive charging or collecting a fee.
____The claimant discharged a representative, or a representative withdrew from the case before we decided the claim, and the representative did not waive charging or collecting a fee.
____A State court declared the claimant legally incompetent and the claimant's legal guardian did not sign the fee agreement.
____There are no past-due benefits.
Prior or Subsequent Applications with Multiple Representatives
____Considering the appointments of representative in the claimant's applications dated [Date of prior application] and [Date of subsequent application], the claimant appointed more than one representative, all did not sign a single fee agreement, and the non-signing representative(s) did not waive charging or collecting a fee.
____Considering the appointments of representative in the claimant's applications dated [Date of prior application] and [Date of subsequent application], the claimant has been declared legally incompetent and the claimant's legal guardian did not sign the fee agreement.

2. Regional Chief Administrative Law Judges' addresses and codes of the Hearing Offices within their Jurisdictions

For the Office of Hearing Operations (OHO) fee agreement issues, see OHO Fee Contacts for a current list of regional chief administrative law judges' addresses and the codes of the hearing offices within their jurisdictions.

NOTE: For a National Hearing Center (NHC) case, send any protest memorandum to the Office of the Regional Chief Administrative Law Judge that has jurisdiction over the region where the claimant is currently residing.

3. Sample Follow-up Memorandum - No Fee Agreement Determination

MEMORANDUM TO:

(Name of the Hearing Office Director)

(City in which the hearing office is located)

or

(Name of AAJ)

Administrative Appeals Judge

Through: Attorney Fee Branch

Office of Appellate Operations

5107 Leesburg Pike, Suite 805 Skyline

Falls Church, Virginia 22041-3255

FROM:

(Title of PC Official)

(PC Involved, e.g., NEPSC, ODO)

SUBJECT:

Determination on Fee Agreement - ACTION

(Claimant's Name and SSN);

On (Date of telephone contact), we advised (the [specify which hearing office] hearing office/your office) by (telephone/e-mail) that the file in the subject claim does not contain a determination on the fee agreement in this case. We asked (the hearing office/your office) to forward a determination on the fee agreement to us within 15 days.

We are unable to authorize a fee for the representative's services until we receive a determination on the fee agreement.

[Use the following paragraph if the representative is an attorney and SSA is withholding past-due benefits for direct fee payment:]

We are withholding $(Amount of past-due benefits withheld for direct payment) of the claimant's past-due benefits for direct payment of a fee to the representative. However, we cannot release any of the withheld funds until we receive the determination on the fee agreement.

Please (request the ALJ to) email the determination to us as soon as possible (fax number [fax number]). If you have any questions, please contact (Name of PC contact) at (Telephone number and email address of PC contact).

(Signature of PC Official)

(Printed Name of PC Official)

cc: [(If addressee is HOD) ALJ]

[(If addressee is AAJ) Deputy Chair, Appeals Council]

Attachments

4. Memorandum to the Regional Chief ALJ - Fee Agreement Approved Incorrectly - ALJ hearing level

MEMORANDUM TO:

Regional Chief Administrative Law Judge

(Address)

FROM:

(Title of PC Official)

(PC Name and Address)

SUBJECT:

Fee Agreement Determination - ACTION

(Claimant's Name and SSN)

On (date), Administrative Law Judge (name) signed an order approving the fee agreement in this case. We do not believe that the approval is correct for the following reason(s). (List Reason(s).)

Copies of the favorable decision, the appointment(s) of representative(s), the fee agreement(s), the order approving the fee agreement, and (any additional relevant information) are available in the electronic folder for your review and action.

We are withholding $(amount) of the claimant's past-due benefits for direct payment to the representative.

Please email your determination to us as soon as possible (email address). If you have any questions, please contact (name of contact) at (contact number/email address).

(Signature of PC Official)

(Name Printed)

Attachments

5. Memorandum to the Deputy Chair, Appeal Council - Fee Agreement Approved Incorrectly - Appeals Council Review level

MEMORANDUM TO:

Deputy Chair, Appeals Council

Office of Appellate Operations

5107 Leesburg Pike, Suite 1400 Skyline

Falls Church, Virginia 22041-3255

FROM:

(Title of PC Official)

(PC Name and Address)

SUBJECT:

Fee Agreement Determination - ACTION

(Claimant's Name and SSN)

On (date), Administrative Appeals Judge (name of AAJ) signed an order approving the fee agreement in this case. We do not believe that the approval is correct for the following reason(s). (Reasons.)

Copies of the favorable decision, the appointment(s) of representative(s), the fee agreement(s), the order approving the fee agreement, and (any additional relevant information) are available in the electronic folder for your review and action.

We are withholding $____ of the claimant's past-due benefits for direct payment to the representative.

Please send your determination to us as soon as possible. If you have any questions, please contact us at (contact information).

(Signature of PC Official)

(Name Printed)

Attachments


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203905065
GN 03905.065 - Exhibits for Fee Authorization under the Fee Agreement Process - 12/10/2019
Batch run: 12/10/2019
Rev:12/10/2019