TN 17 (03-05)
GN 03940.015 Title II - Field Office Processing of Fee Agreements - General
A. Procedure - Initial Claim
1. Unfavorable Decision
Take no action under the fee agreement process for unfavorably decided claims. (But see GN 03940.001D concerning concurrent titles II and XVI claims.)
2. Favorable Decision – District Office Final Authorization (DOFA)
Approve or disapprove the fee agreement, as GN 03940.001D. explains.
Document the determination, providing rationale for a disapproval. Form SSA-553 (Special Determination) may be used for this purpose. (See GN 03940.090 Exhibit 2 for sample language.)
Annotate the SSA-1128 if there is a paper file. (See GN 03910.090, Exhibit 4.)
Determine if a non-attorney representative is eligible for direct payment by checking SSA's list at: Non-Attorney Representatives List and record the results on the MCS DW01 screen as follows:
ISSUE – EDPNA (stands for “eligible direct payment non-attorney)
REC – Input date of verification
REMARKS – Based on information on the list, type “Elgble for Direct Pymnt” (or “EDP”), “Not elgble for direct pymnt” (or “NEDP”), or “Not on list.”
If the non-attorney representative is eligible for direct payment, code the Authorized Representative Type on the NOT2 screen as “4-Eligible for Direct Pay Non-Attorney”. If the non-attorney representative is listed, but is identified as not eligible for direct payment at the time the claim is being processed, or is not listed, at the next step, ensure that the Authorized Representative type on the NOT2 screen is coded “2,” “non-attorney” and that “REP FOR” is typed at the beginning of the address line.
See GN 03920.017B. for the definitions of “representative eligible for direct fee payment” and “representative ineligible for direct fee payment.” See GN 03920.017C. for policy on direct payment to representatives in title II cases.
Follow the instructions in MSOM MCS 009.009 (NOT2 screen), MSOM MCS 008.004 (DW01 screen) and MSOM MCS 014.006 (BCF on BCRN screen). For dual entitlement claims, refer to GN 03940.040.
If the case is a Modernized Claim System (MCS) processing limitation, also complete the Benefit Continuity Field, enter the remark “Fee Agreement Case” and the representative's name and address in the A101 (Automated SSA-101) BCRN Screen, and enter the MADCAP fee agreement paragraphs for inclusion in the award notice in the BCRN screen NOTICE field. Refer to MS MSC 014.
Place the fee agreement and the fee agreement determination at the top of the claim(s) material, below the claim transmittal sheet.
When a concurrent title XVI claim also is involved, place a photocopy of the fee agreement and fee agreement determination in the title XVI claim file.
Send the file to the appropriate processing center (PC).
If you want to know the amount of the authorized fee for the purpose of possibly filing a request for administrative review, check the Single Payment System, the Master Beneficiary Record, or the award notice which is available through the Online Notice Retrieval System. Alternatively, to receive a copy of the notice:
annotate the claim(s) transmittal with “Send a copy of [BIC]'s fee amount authorization to [your name and office address]”, and
code the NOT1 with your name and office address in the third party name and address fields.
See GN 03960.010B.2., GN 03960.010C.1. and GN 03960.010C.2. for further information regarding requesting administrative review under the fee agreement process.
3. Favorable Decision - Non-District Office Final Authorization (DOFA)
Follow steps GN 03940.015A.2.c. - GN 03940.015A.2.f.
Upon verifying the eligibility for direct payment of a non-attorney, record the results on the Modernized Development Worksheet (MDW), following the input directions in GN 03940.015A.2.d.
Do not approve or disapprove the fee agreement because you are not the decision maker in a non-DOFA claim (see GN 03940.002.). Place the fee agreement at the top of the claim(s) material, below the Form SSA-3601. Alert the PC by annotating the claim(s) transmittal with “Fee Agreement Case” and flagging the paper claim file with an SSA-1128.
B. Procedure - Disability Claims
Exclude disability insurance benefits claims, including widow(er)'s and child's insurance based on disability, from the non-medical completion process.
Any claim involving a representative who is eligible for direct fee payment and who has not waived a fee is excluded from non-medical completion.
Treat a claim involving a representative who is not eligible for direct fee payment and has a fee agreement as a non-medical completion exclusion also.
C. Policy - Auxiliary Claim(S)
In many cases, the PC can authorize the final fee only after adjudicating the auxiliary claim(s). GN 03920.030B. discusses past-due benefits of an auxiliary beneficiary(ies). Refer to GN 03920.035B. for policy on withholding from an auxiliary beneficiary(ies) prior to and beginning with the implementation of Title 2 Redesign Release 3 (T2R3) on June 21, 2004.
When an auxiliary claim(s) is delayed and the amount of the fee based on the primary claimant and any non-delayed auxiliary(ies) is less than the statutory maximum indicated in GN 03940.003A.3., the PC authorizes a partial fee based on the known past-due benefits amount from the primary claimant's and any non-delayed auxiliary's(ies') award(s). The notice advises the number holder and representative of the possibility that the fee may increase once SSA adjudicates the delayed auxiliary(ies) claim(s). NOTE: Effective with the implementation of T2R3, if all the auxiliaries do not reside in the same household, the difference between the fee amount paid by the primary claimant and the authorized fee is prorated between/among all the auxiliaries. Refer to GN 03920.035B.2.b. for proration information.
If the claimant filed concurrent titles II and XVI claims, before authorizing an additional fee based on benefits payable to any delayed auxiliary(ies), query the Single Payment System (SPS) to determine if an additional fee was inadvertently authorized based on title XVI past-due benefits before the total title II fee amount was known. Generally, SSA should not authorize the title XVI fee amount until the total title II fee amount (including fees based on the past-due benefits of any auxiliary beneficiaries) is known (see GN 03940.050). However, if SSA inadvertently authorized a title XVI fee amount early, consider that amount in determining whether the fee agreement provisions provide for the authorization of any additional fee amount.
D. Procedure - Auxiliary Claim(s) Delayed
If it is necessary to consider the delayed auxiliary claims in calculating and/or paying the representative's fee because delayed auxiliary claims processing is not fully automated, take the following actions:
1. Completing the Primary Claimant's Award
Follow GN 03940.015A.2. or GN 03940.015A.3. when awarding benefits to the primary claimant and any non-delayed auxiliary(ies). Do not code the fee agreement as “undecided.”
Designate an incomplete notice if the case is processed with a manual award.
Select paragraphs from GN 03940.080, which explain that the fee amount is an interim action subject to change once SSA adjudicates the delayed auxiliary claim(s), and complete the fill-ins necessary for the award notice. For MCS awards, annotate the NOT3 (see MSOM MCS 009.010 ).
2. Completing the Auxiliary Beneficiary's(ies') Award or Disallowance
a. DOFA Award
Follow the instructions in GN 03940.015A.2.e. or GN 03940.015A.2.f. when forwarding the auxiliary claim(s). The last withholding date (LWD) on the NOT2 screen for the protected auxiliary beneficiary(ies) should agree with the number holder's LWD. Refer to MSOM MCS 009.009 . See GN 03920.035B. for policy on withholding from an auxiliary beneficiary(ies).
b. Non-DOFA Award or Denial
Alert the PC when forwarding the auxiliary claim(s) by annotating the claim(s) transmittal with “Fee Agreement Case” and flagging a paper claim(s) file with an SSA-1128. Take no other action on the fee agreement.
E. Procedure - Reconsideration Level
When the claimant files a request for reconsideration and appoints, or already has appointed, a representative, and either one submits, or already has submitted, a fee agreement, take the following actions.
1. Disability Claim
In a claim for disability benefits, including widow(er)'s and child's insurance based on disability, follow the instructions for initial disability claims in GN 03940.010B., GN 03940.015A. and GN 03940.015B.
2. Retirement or Survivors Claim
Because you are not the decision maker at the reconsideration level in a claim for retirement or survivors insurance benefits, follow the general instructions in GN 03940.010B.1. – GN 03940.010B.4., and the instructions for non-DOFA claims in GN 03940.015A.3.
F. Procedure - Hearing or Appeals Council Review Level
Because you are not the decision maker at the Administrative Law Judge (ALJ) hearing or Appeals Council review level, take no action on the fee agreement. Route the fee agreement as shown in GN 03940.010A, GN 03940.010E or GN 03940.010F. Refer to http://eis.ba.ssa.gov/oha/ocalj/directries.htm or DOORS (Detailed Office/Organization Resource System) for hearing office/ALJ routing information.
G. Procedure - PE Issues
The field office (FO) may receive an appointment of representative and a fee agreement when the claimant is pursuing any type of benefit right(s), including post entitlement (PE) actions (e.g., suspension or overpayment) that do not involve adjustment of benefit amounts to which entitlement has already been established (e.g., workers' compensation offset).
1. Claims Representative (CR) Makes Unfavorable Decision
Take no action under the fee agreement process for unfavorably decided PE issues.
2. CR Makes Favorable Decision
If you make a favorable decision on the PE issue, approve or disapprove the fee agreement. (Refer to GN 03940.003D. for information on PE actions that yield past-due benefits.)
The component that effectuates the favorable decision determines the fee authorized under the approved fee agreement. If you want to know the amount of the fee for purposes of possibly filing a request for administrative review (see GN 03960.010B.2., GN 03960.010C.1. and GN 03960.010C.2.), refer to the authorized fee information available through SSA's systems or request a copy of the notice of the fee authorization.
To request a copy of the notice, annotate the claim(s) transmittal as follows:
“Send a copy of [BIC]'s fee amount authorization to [your name and office address].”
3. CR Does Not Make Decision
If you did not make a decision on the PE issue, take no action on the fee agreement. The person who made the favorable decision (i.e., the PC adjudicator, ALJ, or Administrative Appeals Judge) is the decision maker and is responsible for approving or disapproving the fee agreement.