TN 13 (02-05)

GN 03920.033 Representative’s Fee - Title XVI Past-Due Benefits Payable

A. Policy - General

The Act requires a distinction between the "past-due benefits" amount for authorizing the fee under the fee agreement and the "past-due benefits payable" amount for notice purposes. The terms are not interchangeable.

The first check SSA sends to a claimant (“retroactive check”), and to his/her spouse in a title XVI couples case, may include payment(s) for months after the month of effectuation and may include benefits or payments excluded from “past-due benefits” as defined in GN 03920.031C. In these situations, the "past-due benefits" amount for withholding and for calculating the fee under the fee agreement will differ from the "past-due benefits payable" amount (i.e., the amount of the retroactive payment the claimant receives).

B. Policy – Title XVI Past-Due Benefits Payable Calculation

1. Title XVI Only and Title XVI Portion of Concurrent Title II and Title XVI – No Interim Assistance Reimbursement (IAR) Agreement Involved

The "past-due benefits payable" amount in a title XVI claim in which there is no IAR agreement is equal to the amount of the title XVI retroactive check the claimant (and the spouse, in a couples case) will receive after subtracting from past-due benefits the amount:

  • SSA must withhold for direct payment of a representative’s fee(s), if any (see GN 03920.017D, Policy - Direct Payment to Representatives – Title XVI Cases); and/or

  • of a prior overpayment on the claimant or spouse’s record (see GN 03920.031D, Policy - Effect of Overpayment on Title XVI Past-Due Benefits.).

This may or may not include payment for months following the month of effectuation.

2. Title XVI Only and the Title XVI Portion of Concurrent Titles II and XVI Claims - IAR Agreement Involved

a. Representative Ineligible for Direct Fee Payment

The "past-due benefits payable" amount after a payment to a State/subdivision under an IAR agreement is zero when the entire retroactive amount has been sent to the State, even if the State/subdivision subsequently reimburses the claimant for part of the first check, unless the mandatory installment provision applies. (See SI 02003.000, Interim Assistance Payments.)

If total “past-due benefits payable” exceed 3 times (Federal benefit + State supplement) after reimbursement for IAR, the installment process must be used. With the installment process, a one-time payment is sent to the State/subdivision for the exact requested reimbursement amount. “The remaining “past-due benefits payable” are then issued to the claimant in no more than 3 installment payments. Each payment is made at 6-month intervals. Each of the first and second installments cannot exceed 3 times the Federal benefit plus any State supplement (See SI 02101.020, Installment Payments of Large Past-Due Benefits – Individual Alive).

If the eligible SSI disabled/blind individual is under age 18 and total “past-due benefits payable” (plus any federally administered State Supplement) after the IAR payment to a State exceeds 6X the FBR plus any Federally administered State supplement, SSA deposits the residual amount into a dedicated account. (See SI 02101.010, Past-Due Benefits Payable – Individual Alive Under Age 18 with Representative Payee – Dedicated Account Required.)

NOTE: The above information regarding the IAR agreement is for use in addressing questions from the public regarding how much money, if any, the claimant will be paid after the offset deduction and/or any payment to a State/subdivision for IAR from the past-due benefits amount. This definition of "past-due benefits payable" has no bearing on the calculation of the title XVI past-due benefits amount for representative fee purposes.

b. Representative Eligible for Direct Fee Payment

When the claimant has entered into an IAR agreement with the State/subdivision, the title XVI "past-due benefits payable" amount is equal to the amount of the title XVI retroactive check the claimant (and the spouse, in a couples case) will receive after subtracting from past-due benefits, in the order listed, the amount:

  • of reimbursement to the State/subdivision for interim assistance;

  • SSA must withhold for direct payment of a representative