Effective Dates: 12/18/2024 - Present Previous | Next

TN 35 (12-24)

GN 03930.030 Title XVI – Adjudicating Claims and Post-Eligibility (PE) Actions Involving Representatives Who May Petition for Fees

A. Introduction

The claims specialist (CS) in the field office (FO) adjudicates Title XVI claims and PE actions involving representatives who may petition to obtain our approval of fees for their services. The procedures below highlight the key CS responsibilities. The CS must refer to POMS and/or MSOM sections shown for complete processing instructions.

For those cases in which the representative is eligible for direct fee payment and did not waive a fee or the right to direct payment of a fee, including cases in which the eligible representative validly assigned direct payment of the fee to an eligible entity (see GN 03920.021), the CS withholds 25% of the claimant's past-due benefits for direct payment of the representative's authorized fees.

For general policy on direct payment to representatives, see GN 03920.016. For specific policy on direct payment to non-attorney representatives, see GN 03920.018.

B. Policy – CS Responsibilities

Although the CS does not review fee petitions or authorize fees under the fee petition process for services provided in proceedings before us, the CS is involved in the fee petition process in connection with Title XVI claims and PE actions because the CS must do the following:

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    If there are past-due benefits, as defined in GN 03920.031, Representative's Fee – Title XVI Past-Due Benefits, determine if the representative and entity, if there is a valid assignment (see GN 0392.0.021), are eligible for direct fee payment.

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    When we issue a favorable determination or decision and the representative is eligible for direct fee payment and has not waived the fee or direct payment of the fee, ensure that 25% of the claimant's past-due benefits, or the remaining past-due benefits if that amount is less than 25% after we make any interim assistance reimbursement (IAR) are withheld for direct payment of the authorized fee. In addition, ensure that the claimant is issued an underpayment and paid ongoing benefits.

    NOTE: The system automatically withholds 25% of the Title XVI past-due benefits or the remaining past-due benefits if that amount is less than 25% after we make any IAR. This amount is withheld for direct payment of representative’s fees in a Title XVI only claim or the Title XVI claim in a concurrent claim situation. Please note that the Title XVI past-due benefits withheld in a concurrent claim situation are calculated prior to offset of the Title XVI past-due benefits. To ensure that direct payment of an authorized fee does not exceed 25% of past-due benefits in a concurrent claim situation, offset the Title XVI past-due benefits using the instructions in GN 03920.031B.2. prior to direct payment of an authorized fee.

    In addition, the system automatically releases the remaining Title XVI past-due benefits to the claimant after repaying IAR, withholding for representative’s fees, and collecting overpayments. This payment is subject to dedicated account and installment payment provisions – see SI 02101.010 and SI 02101.020.

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    Provide correct notice to the claimant and the claimant's representative. In addition, if the claimant's spouse's past-due benefits are included in the past-due benefits for representative fee purposes, provide correct notice to the eligible spouse when taking actions that affect the spouse's benefits.

    NOTE 1: When sending notices, include only the information the party is entitled to receive. Claimants are entitled to only certain information about auxiliary beneficiaries. See GN 03316.105. Likewise, auxiliary beneficiaries should only receive certain information about the claimant. Notices sent to auxiliary beneficiaries must adhere to the policies articulated in GN 03316.110.

    NOTE 2: We will only provide a copy of the SSA-1560 or other fee authorization document to the POC if the POC filed the fee petition in the limited circumstances described in GN 03920.020.

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    In a Title XVI only claim, if we are withholding the claimant's past-due benefits for possible direct fee payment, diary an administratively decided case for 60 days for receipt of the fee petition, and follow up if no fee petition has been submitted within 60 days from the date we mailed notice of the claimant's favorable determination or decision. Diary a claim decided by a Federal court for 120 days. See GN 03930.045 for further information about these diaries.

    NOTE 3: In favorably decided concurrent Titles II and XVI claims, the processing center (PC) sets the diary for receipt of the fee petition and performs necessary follow-ups when we are withholding the claimant's past-due benefits.

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    If the file is paper, decide whether the FO has alerted the Office of Appellate Operations (OAO), or forwarded to the Hearing Office (HO) or the PC the Title XVI claim(s) file for necessary action on a fee petition.

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    When the fee authorization is received from OAO, the HO, or the PC, if the representative and the entity, if there is a valid assignment, are eligible for direct payment, manually release the fee payment or the balance of the fee payment, if any, in concurrent Titles II and XVI claims to the representative (or entity, if there is a valid assignment) to the extent that the withheld Title XVI benefits permit; recover any outstanding overpayment; and release any excess withheld past-due benefits to the claimant unless there is Federal court involvement. Refer to SM 01901.950 for instructions on manually processing representative fee payments.

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    In concurrent claims situations, make any necessary adjustments to the Title II income as described in SI 00830.100 and SI 02006.200.

C. Procedure

1. Reviewing the Representative Information on the Supplemental Security Record (SSR)

Review the electronic file (eView), paper claim(s) file if available, and the Registration, Appointment and Services for Representatives (RASR) application to identify all appointed representatives. Determine the status of prior representatives, if applicable. Determine which representatives, if any, are eligible for fees and for direct payment. Ensure that the SSR reflects the identity of the claimant's principal representative and the representative's eligibility for direct payment. If the representative is eligible for direct payment, review RASR to determine whether the representative has waived their right to direct payment. To determine if a representative is eligible for direct payment, take the actions in GN 03930.030C.2. If the representative has validly assigned direct payment of authorized fees to an entity, review GN 03920.021 for the requirements for an entity to be eligible for direct payment.

If a representative is not on the SSR, take the following actions:

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    Determine if the representative is eligible for direct payment using the instructions in GN 03930.030C.2. If the representative has validly assigned direct payment of their authorized fees to an entity, review GN 03920.021 for the requirements for an entity to be eligible for direct payment.

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    Initial Claims: Complete the UMEN, UATH and UFEE screens using the instructions in MS 00302.012 - Appointed Representative Processing, MS 00302.013 - Authorized Representative (UATH), and MS 00302.014 - Representative Fee Update Data (UFEE).

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    Posteligibility Actions: Complete the UMEN, UATH and UFEE screens using the instructions in MS 00302.012 - Appointed Representative Processing, MS 00302.013 - Authorized Representative (UATH), and MS 00302.014 - Representative Fee Update Data (UFEE).

After ensuring that the SSR is correctly coded:

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    Go to GN 03930.030C.3. if the representative and entity, if there is a valid assignment, are eligible for direct payment.

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    Continue effectuating the determination or decision without withholding past-due benefits if no representative is eligible for direct payment and there is no Federal court involvement.

2. Determining Representatives' Eligibility for Direct Fee Payment

These procedures apply to favorable determinations or decisions we effectuate.

  1. a. 

    Attorneys: To determine an attorney's eligibility to receive direct payment, review the criteria in GN 03920.016B.1. Return to GN 03930.030C.1.

  2. b. 

    Non-attorney representatives: To determine a non-attorney's eligibility to receive direct payment, follow the instructions in GN 03920.016B.1. and GN 03920.018.

    Check the RASR EDPNA Query to determine if the non-attorney is eligible for direct payment at the time of effectuation.

    • –

      If the representative is listed, go to GN 03930.030C.2.c.

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      If the representative states that they are eligible for direct payment, but are not listed on that date, take the action in GN 03930.030C.2.d. and then return to GN 03930.030C.1.

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      If the representative did not state that they are eligible for direct payment and is not listed, continue effectuating the determination or decision without withholding past-due benefits if no representative is eligible for direct payment and there is no Federal court involvement.

  3. c. 

    If RASR indicates the non-attorney representative is eligible to receive direct payment and has not waived direct payment, verify that there is a valid appointment in the file. For information that is required for a valid appointment, see GN 03910.040.

  4. d. 

    If the non-attorney stated that they are eligible for direct payment but they are not, notify the representative that we cannot make direct payment and send a copy to the claimant (see model language below). Continue effectuating the determination or decision without withholding past-due benefits if no representative is eligible for direct payment and there is no Federal court involvement.

Model language to use in these situations follows:

You advised your client, (Recipient's name), and indicated on (the Form SSA-1696 (Claimant's Appointment of a Representative) OR notice of appointment [Use only for an appointment signed by the claimant before December 9, 2024 where the representative did not submit a Form SSA-1696]) that you are a non-attorney who is eligible to have authorized representatives' fees withheld and paid directly from a claimant's past-due benefits. However, [Select the conclusion that describes the status]:

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    you are not eligible to receive direct payment of the authorized fee,

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    you did not become eligible to receive direct payment of the authorized fee until after we effectuated the favorable decision on your client's claim, or

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    you failed to maintain your eligibility to receive direct payment of the authorized fee and were no longer eligible on the date we effectuated the favorable decision on your client's claim.

Accordingly, we will not pay any authorized fee directly to you. You should look to the claimant for payment of the fee authorized in this case.

3. Determine Entity's Eligibility for Direct Payment

If the eligible representative validly assigned direct payment of the fee to an entity, determine if the entity is eligible to receive direct payment. Verify that the entity is registered and has not been placed on the Ineligible for Direct Payment Entity (IDPE) list in RASR. See GN 03920.021B.2. for further information on determining an entity's eligibility to receive direct payment and actions to take if the entity is ineligible.

4. Adjudicating a Claim and Withholding Past-Due Benefits

If we issued a favorable Title XVI only or concurrent favorable Titles II and XVI determination or decision, there are Title XVI past-due benefits, and the representative is eligible for direct payment and did not waive a fee or direct payment:

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    Annotate the UFEE screen to show that the Fee Situation is unresolved (see MS 00302.014, Representative Fee Update Data (UFEE));

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    Ensure that Direct Payment Waived is answered “N” on the UFEE screen; and

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    Go to GN 03930.030C.3.a. through GN 03930.030C.3.d. as the claim warrants.

See GN 03920.031 for guidance in calculating a claimant's past-due benefits for representative fee purposes.

a. No Interim Assistance Reimbursement (IAR) Involvement – No Prior Overpayment

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    Input a U TAC to the SSR to withhold 100 percent (%) of past-due benefits. See MS 00304.018, Underpayment Processing (UOUP).

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    Adjudicate the claim (i.e., calculate benefits, net past-due benefits for a current overpayment, and pay ongoing benefits).

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    Establish for resolution a FEE PETITION issue on the Development Worksheet (or the MDW on a non-MSSICS claim) and set a follow-up date. Counting from the date of the FO action, set a 60-day follow-up in a case resolved by us or a 120-day diary for a case resolved in Federal court proceedings.

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    Input an automated one-time payment (A-OTP) to pay claimant 75% of past-due benefits or the first installment of that amount, if required. See SM 01901.000, One-Time Payments Process; SI 02101.010, Past-Due Benefits Payable – Individual Alive Under Age 18 with Representative Payee – Dedicated Account Required; and SI 02101.020 Large Past-Due Supplemental Security Income (SSI) Payments by Installment – Individual Alive.

    NOTE: In Title XVI only claims, the withheld amount is 25% of the Title XVI retroactive benefits (i.e., past-due benefits) and the amount payable to the claimant is 75% of past-due benefits. In concurrent claims, we reduce the Title XVI past-due benefits amount by the Title XVI offset amount for the same period, regardless of whether the actual offset, as provided under §1127 of the Act, reduces the Title II or Title XVI benefits. Therefore, in concurrent claims, 25% of the Title XVI past-due benefits for fee purposes will usually be less than 25% of the total SSI retroactive payments. After determining the amount of past-due benefits for representative fee purposes, there may be more than 75% of the actual retroactive benefits available to pay to the claimant.

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    Send a manual notice to the claimant and representative. Refer to GN 03930.030C.4.

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    If the FEE PETITION issue follow-up date arrives before the fee petition is received, go to GN 03930.030C.6. When the fee authorization is received, go to GN 03930.032.

b. No IAR Involvement – Prior Overpayment

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    Delete overpayment collect decisions in the Overpayment Decision Data (OPDD) segment of the existing SSR that relate to an overpayment from a period not adjudicated by the favorable determination or decision (i.e., a prior overpayment). When the overpayment collect decision is deleted, a diary will be established. The diary will serve as a reminder to re-post the overpayment collect decision. See MS 00304.007, Add/Change/Delete Overpayment Decisions (UODC).

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    Input a U TAC to the SSR to withhold 100% of past-due benefits.

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    Adjudicate the claim (i.e., calculate benefits, net past-due benefits for a current overpayment, and pay ongoing benefits).

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    Establish for resolution a FEE PETITION issue on the Development Worksheet (or the MDW in a non-MSSICS claim) and set a follow-up date. Counting from the date of the FO action, set a 60-day follow-up in a case resolved by us or a 120-day diary for a case resolved in Federal court proceedings. See GN 03930.045 for further information about these diaries.

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    If the overpayment is less than 75% of past-due benefits, input an A-OTP to pay the claimant the difference between 75% of past-due benefits and the overpayment amount, or the first installment of that amount, if required. If the overpayment is more than 75% of past-due benefits, make no payment to the claimant. See SI 02101.010, Past-Due Benefits Payable – Individual Alive Under Age 18 with Representative Payee – Dedicated Account Required; and SI 02101.020 Large Past-Due Supplemental Security Income (SSI) Payments by Installment – Individual Alive.

    NOTE: In a concurrent claim, refer to the Note in GN 03930.030C.3.a.

  • •

    Send a manual fee notice to the claimant and representative. Refer to GN 03930.030C.4.

    NOTE: Even if there is a valid assignment, do not send a copy of this notice to the POC without the claimant's express written consent. We will only provide a copy of the 20-day closeout notice (see GN 03930.060A.3.) to the POC or other individual listed in GN 03930.020A when we have information confirming that the representative has died. We will only provide a POC or other individual listed in GN 03930.020A with a copy of the SSA-1560 or other fee authorization document when that individual filed the fee petition.

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    If the FEE PETITION issue follow-up date arrives before the fee petition is received, go to GN 03930.030C.6. When fee authorization is received, go to GN 03930.032.

c. IAR Involved – No Prior Overpayment Pending

Past-due benefits equal to or greater than $5,000 - If the underpayment or past-due benefits due to the claimant are equal to or greater than $5,000, the CS must complete the underpayment review and enter the appropriate code on the Underpayment Processing (UOUP) screen (see MS 00304.018, Underpayment Processing (UOUP)) to show that the prepayment review is complete. The system will generate an online build transaction SSR alert message: I9 ALERT – REQUIRES IAR TO BE PAID BY OTP. When the CS receives the message, the CS continues with the transaction. The system will set the underpayment verification code to “V” (UPV:V), withhold 100% of past-due benefits, and send an automated notice to the State to request the IAR amount. In these cases, when the response is received from the State, take the actions in the bullets below.

Past-due benefits less than $5,000 - If the underpayment is less than $5,000, the system will set the underpayment verification code to “V” (UPV:V), withhold 100% of past-due benefits, and send an automated notice to the State to request the IAR amount. (See SI 02003.025, IAR Payment Processing for Exception Cases and Proration Cases.) In these cases, when the response is received from the State, take the actions in the bullets below.

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    If the IAR is less than 75% of the past-due benefits:

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      Input a U TAC into the SSR to continue withholding 100% of past-due benefits (U TAC replaces UPV:V).

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      Input an A-OTP to pay the State the IAR amount. This also produces an automated notice to the State.

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      On the next workday, add an A-OTP to pay the claimant the difference between 75% of past-due benefits and the IAR amount, or the first installment payment if required. (Past-due benefits that are being withheld by U TAC minus IAR minus 25% of past-due benefits [if concurrent case, as defined in GN 03920.031B.2. = benefits due claimant in one payment or installments.)

    • –

      Establish for resolution the FEE PETITION issue on the appropriate claims Development Worksheet and set a follow-up date. Counting from the date of the FO action, set a 60-day follow-up in a case resolved by us or a 120-day diary for a case resolved in Federal court proceedings.

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    If the IAR is equal to or greater than 75% of the past-due benefits, there are no benefits due claimant at this time.

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      Input a U TAC to the SSR to continue withholding 100% of past-due benefits (U TAC replaces UPV:V).

    • –

      Input an A-OTP to pay the State the IAR amount. This also produces an automated notice to the State.

    • –

      Establish the FEE PETITION issue on the claims Development Worksheet for resolution and set a follow-up date. Counting from the date of the FO action, set a 60-day follow-up for a case resolved by us or a 120-day diary for a case resolved in Federal court proceedings.

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    If past-due benefits minus IAR equals zero, there are no benefits for direct fee payment and no past-due benefits due to the claimant.

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      Input an A-OTP to pay the State the IAR amount. This also produces an automated notice to the State.

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      Send a manual notice to the claimant and representative to advise that payment of any fee we authorize is between the claimant and the representative.

      NOTE: In a concurrent claim, refer to the NOTE in GN 03930.030C.3.a.

    • –

      If the FEE PETITION issue follow-up date arrives before the fee petition or authorization is received, go to GN 03930.030C.6. When fee authorization is received, go to GN 03930.032.

d. IAR Involved – Prior Overpayment Pending

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    Delete the overpayment collect decision for any overpayment with a collect decision in the OPDD segment of the existing Title XVI record. This removes an overpayment decision for an overpayment from a period not adjudicated by the favorable determination or decision (i.e., a prior overpayment). When the overpayment decision is removed, a diary will be established. The diary will serve as a reminder to re-post the overpayment collect decision. UPV:V (for IAR) withholds 100% of past-due benefits and sends an automated notice to the State for the IAR amount (see SI 0311.030 and SM 01311.045).

  • •

    Adjudicate the claim (i.e., calculate benefits, net past-due benefits for a current overpayment, and pay ongoing benefits.)

  • •

    When the response is received from the State, input a U TAC to continue withholding 100% of past-due benefits.

  • •

    Input an A-OTP to pay the State the IAR amount. This produces an automated notice to the State.

  • •

    If past-due benefits minus IAR is greater than zero, establish for resolution a FEE PETITION issue on the Development Worksheet (or MDW in a non-MSSICS claim) and set a follow-up date. Counting from the date of the FO action, set a 60-day follow-up for a case resolved by us or a 120-day diary for a case resolved in Federal court proceedings.

    If past-due benefits minus IAR is zero, there is no withholding for fee payment. Send a manual fee notice to advise the claimant accordingly.

  • •

    If there are remaining past-due benefits, send a manual fee notice to the claimant and representative. Refer to GN 03930.030C.4.

  • •

    If the FEE PETITION issue follow-up date arrives before the fee petition is received, go to GN 03930.030C.6. When the fee authorization is received, go to GN 03930.032.

5. Preparing Fee Notice

If the initial or reconsideration determination on a Title XVI only claim was favorable, there are past-due benefits, and the representative is eligible for direct fee payment, send a manual fee notice to the claimant with a copy to the representative to advise that we are withholding the claimant's past-due benefits for possible fee payment and that the representative must file a fee petition or a statement of intent to file a fee petition within 60 days of the date of the favorable determination in order to receive direct payment from the claimant's withheld past-due benefits.

If we include the claimant's eligible spouse's past-due benefits in the claimant's past-due benefits for representative fee purposes, send a fee notice to the spouse with a copy to the representative whenever we take an action that affects the spouse's benefits.

NOTE: When sending notices, include only the information the party is entitled to receive. Claimants are entitled to only certain information about auxiliary beneficiaries. See GN 03316.105. Likewise, auxiliary beneficiaries should only receive certain information about the claimant. Notices sent to auxiliary beneficiaries must adhere to the policies articulated in GN 03316.110.

If we are withholding past-due benefits on a Title XVI only claim favorably resolved by a Federal court, refer to GN 03930.040G. for sample language to include in the fee notice to the court attorney.

6. Sending Copies of Notices

Send a copy of the claimant's notice and the spouse's notice, if pertinent, to the representative. Also send a copy to the representative payee and/or legal guardian, if applicable.

NOTE 1: Although a representative who withdrew their appointment or was discharged by the claimant may file a fee petition, do not send a copy of the award notice or other protected information (e.g., the claimant’s information) unless it is the minimum amount necessary for the former representative to review it to resolve fee-related issues. For information that is not relevant or necessary to resolve fee-related issues, only disclose it if the claimant has expressly consented in writing on a Form SSA-3288 or other written consent that meets the requirements of GN 03305.003. We may still provide a copy of the 20-day closeout notice (see GN 03930.090A.3.) to the terminated representative.

NOTE 2: Even if there is a valid assignment of direct payment to an entity, do not send a copy of the award notice or other protected information (e.g., the claimant’s information) to the entity’s POC unless it is the minimum amount necessary for the POC to review it to resolve fee-related issues. For information that is not relevant or necessary to resolve fee-related issues, only disclose it if the claimant has expressly consented in writing on a Form SSA-3288 or other written consent that meets the requirements of GN 03305.003. We will only provide a copy of the 20-day closeout notice (see GN 03930.090A.3.) to the POC or other individual listed in GN 03930.020A when we have information confirming that the representative has died, and we will send the SSA-1560A or other fee authorization document to the POC or other individual listed in GN 03930.020A when that individual filed the fee petition.

NOTE 3: Representative payees are entitled to only certain information about the claimant in order to perform their duties. Notices to representative payees must adhere to these limitations (see GN 03316.120). Do not send a copy of the spouse’s notice to the claimant’s representative payee.

7. Responding to a Matured FEE PETITION Issue Follow-up Date

a. Title XVI Only Claim

For a Title XVI only claim, if within 60 days, the FO does not receive a fee authorization from the PC, the HO, or OAO, and the representative, or other individual listed in GN 03930.020A when the representative is deceased, does not submit a fee petition, an intent to file a fee petition, or a statement that the representative waives the fee or waives direct payment, follow the procedures in GN 03930.090.

If within 120 days the FO does not receive a fee authorization from the court, follow the procedures in GN 03930.091.

For additional guidance on diaries, see GN 03930.045.

When the fee petition is received, go to GN 03930.030C.7.

b. Concurrent Titles II and XVI Claims

The PC diaries receipt of the fee petition and fee authorization. If within 60 or 120 days, the FO does not receive a fee authorization from the PC, the HO, or OAO, reestablish for resolution a FEE PETITION issue on the Development Worksheet and set a follow-up date for 60 days.

If the fee petition is received in the FO, go to GN 03930.030C.7.

8. Notifying OAO, the HO, or the PC after Petition Received that the Title XVI Claim is Ready for Processing

For Title XVI only and concurrent Titles II and XVI claims, before notifying OAO, the HO, or the PC that the Title XVI claim is ready for necessary action on a fee petition filed by the representative, or other individual described in GN 03930.020A when the representative is deceased, fully adjudicate the Title XVI claim or resolve any existing post-entitlement issues (as GN 03930.025B. and GN 03930.025C. describe).

D. References

The following sections provide specific instructions for related CS functions:

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    GN 03910.040 FO actions on receiving Form SSA-1696 (Claimant's Appointment of a Representative)

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    GN 03910.050 Contacting a represented claimant

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    GN 03920.020D FO action when representative waives a fee or direct payment of a fee

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    GN 03930.025 Receipt and routing of fee petitions

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    MS 00302.013 Authorized Representative (UATH)

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    MS 00302.012 Appointed Representative Processing

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    MS 00302.014 Representative Fee Update Data (UFEE)

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    NL 00801.015 Notice Suppression on Start Date Cases

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    NL 00802.010 Initial Award Notice — SSA-L8025, SSI Notice of Award

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    NL 00802.030 SSA-L8165, SSI Important Information

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    SM 01901.000 One-Time Payments

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    MS 05701.001 Single Payment System (SPS) - Overview

 

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To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203930030
GN 03930.030 - Title XVI – Adjudicating Claims and Post-Eligibility (PE) Actions Involving Representatives Who May Petition for Fees - 12/18/2024
Batch run: 12/18/2024
Rev:12/18/2024