TN 7 (07-04)

GN 03930.145 Exhibit-Model Letter - Claimant Not Provided a Copy of Petition

Social Security Administration

Important Information

Program Service Center
Street Address
City, State ZIP
Date:
Claim/Case Number

 

Claimant's Name
Street Address
City, State ZIP

 

(Representative's Name) recently asked us to approve a fee of $(dollar amount) for representing you in your case before Social Security. We have enclosed a copy of this request.

Please let us know if you disagree with the fee requested or any information shown in the request. If you disagree, you must contact us within 20 days of receiving this letter. We will not address (Mr./Ms. representative's last name)’s request until after that time.

You may call us about this matter at (area code and phone number), or write to us using the enclosed self-addressed envelope. If you have questions about other Social Security matters, you may call us toll free at 1-800-772-1213, or call your local Social Security office at xxx-xxx-xxxx. We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at:

Street Address
City, State ZIP

If you do call or visit an office, please have this letter with you. It will help us answer your questions. This will help us serve you more quickly.

 

Assistant Regional Commissioner,
Processing Center Operations

Enclosures:

Fee Request
Self-addressed Envelope

 

cc:
Representative's Name


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203930145
GN 03930.145 - Exhibit-Model Letter - Claimant Not Provided a Copy of Petition - 11/24/2010
Batch run: 11/24/2010
Rev:11/24/2010