If a representative who is eligible for direct payment does not want to receive direct
payment of his or her fee from the claimant's past-due benefits, the representative
complete Part III of form SSA-1696-U4 by checking the box ‘Charging a fee but waiving
direct payment' and providing signature and date; or
sign the "Waiver of Direct Payment" section of the SSA-L1697-U3; or
submit a written statement that clearly and unequivocally states that he or she waives
direct payment of fees by SSA from past-due benefits.
The representative's written statement waiving the right to direct payment constitutes
a waiver of direct payment of all fees for services in a case, including any related
auxiliary beneficiary's portion of the fee, and any court- authorized fee. In concurrent
claims, the waiver applies to both Title II and Title XVI cases.
If we learn of a representative's waiver of direct fee payment before we make direct
payment, we will act on the waiver. In favorably decided concurrent claims, if a portion
of the fee is payable from both the Title II and the Title XVI past due benefits,
we will act on the waiver if we receive the waiver before we make the first fee payment
to the representative.
EXAMPLE 1: An ALJ issued a favorable Title II decision and approved a fee agreement on January
2. On January 4, the hearing office (HO) received the representative's waiver of direct
payment, date-stamped it, and faxed it to the Processing Center (PC). The PC associated
the waiver statement with the claims file before the favorable decision was effectuated
and was able to release the entire amount of past-due benefits to the claimant without
withholding 25 percent for direct payment of the representative's fee. This is the
EXAMPLE 2: An ALJ issued a favorable concurrent decision and approved a fee agreement on March
3. The PC issued direct payment of the representative's fee based on the Title II
past due benefits on March 30 and notified the FO of its action. On April 10, the
HO received the representative's waiver of direct payment, date-stamped it, and faxed
it to the PC. The PC forwarded the waiver statement to the FO. Because we did not
receive the waiver statement before making direct payment on the Title II claim, we
paid the additional fee based on the claimant's Title XVI past-due benefits directly
to the representative.
If we associate the waiver statement after we issue direct payment and the representative
questions the payment see, Representative's Fee - Erroneous Direct Payment and Assessment
If a representative waives direct payment of the fee from past due benefits but intends
to charge and collect a fee from either the claimant or any auxiliary beneficiary,
we must authorize the fee for services provided in proceedings before us unless the
provisions in GN 03920.010B.2 apply.