Paper claims |
Step
1.
Affix
the
Form SSA-1128 (Representative Involved) to
the front lower right corner of the paper claim
folder
and indicate
whether:
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•
the representative is an attorney, EDPNA, or a non-attorney who is not eligible for
direct pay;
-
-
•
the representative waives a fee;
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•
the representative waives only direct payment of the fee from withheld past-due benefits;
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•
the claim is Title II, Title XVI, or concurrent;
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•
a third party has paid or will pay the representative's fee. See GN 03920.005B and GN 03920.010B for information on our authorization of fees when paid by a third-party entity; and
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•
the representative submits a fee agreement, but you are not the decision maker. Check
the block on the Form SSA-1128 labeled “Fee Agreement in File,” but do not check either
the “Approved” or “Disapproved” block. See GN 03940.002 for information on the fee agreement decision maker.
Step
2. Enter information in RASR and file the written notice of
appointment in the claim
file.
-
a.
Representative is in RASR.
-
1.
Enter the information in RASR, which will send the necessary notices and acknowledgments
to the appointed representative.
-
2.
Enter the information also in MCS and MSSICS to ensure the representative's information
propagates into all claims systems.
-
3.
When an affected auxiliary beneficiary's information becomes available, enter this
information and ensure that system has created a link.
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b.
Representative is not in RASR.
-
1.
When the representative is an attorney or EDPNA and is eligible for and seeking direct
payment of a fee but is not in RASR, process the written notice of appointment outside
of RASR as explained in 2a below. Explain to the representative that our regulations
require that representatives who are eligible
for and seek direct payment of their fees must register with us. Once the representative is registered for direct
payment, enter his or her information in RASR. Refer to 71 FR 58043 and GN 03913.000 for information on individual registration for appointed representative
services and direct payment of fees. If the representative (attorney or EDPNA) is
eligible for but not seeking direct payment, process his or her appointment as explained
in step 2a below.
-
2.
If the representative is a non-attorney who is not eligible for direct pay, you may
contact him or her and ask if he or she would like to register in RASR for access
to electronic services as explained in GN 03913.020B.
-
a.
If the non-attorney declines to register, file the written notice of appointment in
the Title II claim file and a copy in the Title XVI claim file and process the appointment
outside of RASR as follows: (1) send manual notices from Document Processing System
(DPS) to acknowledge the appointment; and (2) annotate the required downstream applications
(e.g., MCS and MSSICS) with the representative's name, address, and phone number (in
multiple representative situations, enter the principal's representative's name, address,
and phone number); and, if applicable, information about a fee agreement or waiver
of fee, if any.
-
b.
If the non-attorney representative agrees to register, secure a Form SSA-1699 and
process it as explained in GN 03913.005. Unless other reasons prevent recognition of the appointment, process the appointment
as you would for unregistered representatives. Once the non-attorney is registered,
enter the appointment data in RASR. This is a one-time registration process
done for non-attorney representatives who want
access to electronic services.
Step 3. Other systems
-
a.
In pending Title II and Title XVI claims:
-
1.
Add DW01 issue of “1696,” as explained in MS 03508.004 in MCS and MSSICS. See DI 31001.000 for information on claimant representation.
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2.
Annotate the NOT2 screen in a Title II MCS claim, as explained in MS 03509.009.
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3.
In a Title II non-MCS claim, annotate the Special Message field of the Master Beneficiary
Record (MBR) (after MBR is established) as explained in MS 06307.008 and obtain an
Inquiry Response Identification (QRID) query as explained in MS 05206.002 and MS 05206.022.
-
4.
In Title XVI claims, annotate the UATH and UFEE screens, if any fee information is
applicable and available (i.e., appointed representative is eligible for and requesting
direct payment).
-
b.
In reconsideration requests and hearing requests on MCS, annotate the system, as explained
in MS 03510.004 or MS 03510.006, as applicable.
-
c.
In post-entitlement situations, if you need to answer questions about the record posed
by a claimant or an appointed representative, query the system as explained in MS
05206.002, MS 05206.022, and MS 05206.023. This query accesses representative identification
information gathered from the MBR, SSR, and the Authorized Representative File on
the Modernized Data Input.
Step 4. PC systems
-
a.
To send an action request for the PC, use “Paperless” to fax items and create in the
Payment Center Action Control System (PCACS).
-
b.
Use the Non-Disability Repository for Evidentiary Documents (NDRed) to store Title
II and Title XVI documents and material for claims that do not have an electronic
folder.
-
c.
Annotate the system if a Federal reviewing official, the Office of Hearing Operations
(OHO), or the Office of Appellate Operations (OAO) notifies the FO that it has received
an appointment of representative.
NOTE: When the claimant revokes the representative's appointment or the representative
withdraws before we issue a favorable determination or decision and the claimant does not appoint
another representative, remove the Form SSA-1128 from the paper claim file, the appointed
representative’s information from the NOT2 screen in MCS and UATH screen in MSSICS,
and terminate the appointment in RASR. The revoked or withdrawn representative is
not entitled to direct payment. Terminating the appointment in RASR will break the
link between the representative and the pending claim, matter, or issue and prevent
direct payment of a fee, if any. See the NOTE in GN 03920.017A for information on when we do not withhold the claimant's past due benefits for direct
payment of an authorized fee to a representative.
When the claimant revokes the representative's appointment or the representative withdraws
after we issue a favorable determination or decision, remove the Form SSA-1128 from the
paper claim and process direct payment of the authorized fee as explained in SM 00834.001
for Title II claims or SM 01901.000 for Title XVI claims. Representatives who are
revoked or withdraw after we issue a favorable determination or decision are entitled to direct payment from
us. If necessary, develop for the date of revocation or withdrawal if the date is
not shown on the statement of revocation or withdrawal.
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Electronic
claims
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Step 1. Enter information in RASR and downstream applications (e.g., MCS,
MSSICS, and EDCS) as explained in Step 2 above. If processing the written notice of appointment outside of RASR:
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•
upload the written notice of appointment into the electronic folder;
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•
send manual notices from DPS to acknowledge the appointment;
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•
annotate the required downstream applications (e.g., MCS and MSSICS) with the representative’s
name, address, and phone number. If the claimant appoints multiple representatives,
enter the principal representative’s name, address, and phone number; and
-
•
if applicable, enter information about a fee agreement or waiver of a fee, if any.
Step 2. Add the Representative
flag.
If a representative enters the case before you send the medical file to the Disability
Determination Services (DDS), OHO, or OAO, add the Representative flag for an electronic
folder in disability claims. See DI 81020.085 for information on certified electronic folder flags.
If the case is at the reconsideration or hearing level and jurisdiction has changed,
activate the flag and send an update after transfer (UAT) in EDCS.
Step 3. Enter information in other
systems as explained in Step 3 above and annotate the EDCS
transfer screen.
See DI 81010.085 for information on transferring cases in EDCS.
Step 4. Enter information in PC
systems as explained in Step 4 above.
NOTE: When the claimant revokes the representative's appointment or the representative
withdraws before we issue a favorable determination or decision and the claimant does not appoint
another representative, remove the Representative flag from EDCS, the appointed representative’s
information from the NOT2 screen in MCS and UATH screen in MSSICS, and terminate the
appointment in RASR. The revoked or withdrawn representative is not entitled to direct
payment. If the pending claim, matter, or issue is at the initial, reconsideration,
or hearing level, send an UAT in EDCS. Terminating the appointment in RASR will break
the link between the representative and the pending claim, matter, or issue and prevent
direct payment of a fee, if any. See the NOTE in GN 03920.017A for information on when we do not withhold the claimant's past due benefits for direct
payment of an authorized fee to a representative.
When the claimant revokes the representative's appointment or the representative withdraws
after we issue a favorable determination or decision, terminate the appointment in RASR
and process direct payment of the authorized fee as explained in SM 00834.001 for
Title II claims or SM 01901.000 for Title XVI claims. Representatives who are revoked
or withdraw after we issue a favorable determination or decision are entitled to direct payment from
us. If necessary, develop for the date of revocation or withdrawal if the date is
not shown on the statement of revocation or withdrawal.
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