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

TN 51 (12-24)

GN 03940.015 Title II - Field Office Processing of Fee Agreements - General

A. Initial Claim

1. Unfavorable Decision

Take no action under the fee agreement process for unfavorable decisions and determinations (hereinafter we generally refer to both as a “decision”). But see GN 03940.001D concerning concurrent Titles II and XVI claims.

2. Favorable Decision – District Office Final Authorization (DOFA)

  1. a. 

    Approve or disapprove the fee agreement, using the instructions in GN 03940.003.

  2. b. 

    Document the determination, providing rationale for a disapproval. Form SSA-553 (Special Determination) may be used for this purpose. (See GN 03905.065 Exhibit 1 for sample language.)

  3. c. 

    Annotate the SSA-1128 (Representative Involved) if there is a paper file. (See GN 03905.025.)

  4. d. 

    Determine if a non-attorney representative is eligible for direct payment by checking the Registration, Appointment, and Services for Representatives (RASR) EDPNA (eligible for direct payment non-attorney) Query and record the results on the Modernized Claim System (MCS) DW01 screen as follows:

    ISSUE – EDPNA

    REC – Input date of verification

    REMARKS – Based on information on the list, type “Eligible for Direct Payment” (or “EDP”), “Not eligible for direct payment” (or “NEDP”), or “Not on list.”

    If the non-attorney representative is eligible for direct payment, the NOT2 screen should show “Eligible for Direct Pay Non-Attorney.” If the non-attorney representative is not eligible for direct payment at the time the claim is being processed, verify that the Appointed Representative type on the NOT2 screen shows “2,” “non-attorney.” Make any corrections or changes needed in RASR.

    See GN 03920.016B. for the requirements for representatives to receive direct payment.

    If a representative has validly assigned direct payment of their authorized fee to an entity as set forth in GN 03920.021, determine if that entity is eligible to receive direct payment of fees by querying RASR to ensure that the entity has registered and not been placed on the Ineligible for Direct Payment Entity list.

  5. e. 

    Follow the instructions in MS 03509.009 (NOT2 screen), MSOM MCS 008.004 (DW01 screen) and MSOM MS 03514.006 (BCF on BCRN screen). For dual entitlement claims, refer to GN 03940.040.

  6. f. 

    If the case is a MCS processing limitation, also complete the Benefit Continuity Field (BCF), 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 03514.006.

  7. g. 

    Ensure that the fee agreement and the fee agreement determination are associated with the claim(s) file and loaded to Evidence Portal.

  8. h. 

    Notify the appropriate processing center (PC). If the claim(s) file is paper, send the file to the appropriate PC.

  • •

    To determine 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 Retrieval System (ORS), eView, or Evidence Portal.

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 representative, 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). Ensure that the fee agreement is associated with the claim(s) file and loaded to Evidence Portal. Alert the PC by email or other reliable method and flag a paper claim file with an SSA-1128.

4. Favorable Decision — No Past-Due Benefits

  • •

    NOT2 for Fee Agreement Type - Leave blank.

    • –

      MCS will automatically code ATY04 to DW01 when NOT2 "Fee Agreement Type" is blank.

  • •

    NOT2 for Fee Agreement % — Leave blank.

  • •

    NOT2 for Fee Agreement Amount — Leave blank.

  • •

    NOT2 for the Last Withholding Date — Enter the month prior to the month of adjudication, see GN 03920.030B.

  • •

    On the DW01 screen, receipt in the automatic ATY04 with "XXXXXX".

  • •

    Add a new issue for ATY00.

    • –

      Add the remark "no past-due benefits" next to the ATY00 issue.

  • •

    Add an RPOC to document disapproval of the fee agreement because no past-due benefits are involved.

  • •

    Notice must advise the claimant and the representative(s) that the representative must file a fee petition for authorization to charge and collect the representative's fee.

    • –

      For cases adjudicated via MCS EC, no additional notices are required, MCS will generate the correct notice.

    • –

      For cases not adjudicated via MCS EC at the initial or reconsideration levels, include the notices on the A101/EF101 in the remarks/notice fields. Technicians will include ATYR15.

      NOTE 1: If the representative assigned direct payment of their fee to an entity and we receive information or discover that the representative has died, send a copy of this notice to the entity’s point of contact (POC). For information on assigning direct payment of fees, including the roles and responsibilities of a POC, see GN 03920.021.

  • •

    Delete the automated 098/099 diary on the DECI screen, since there are no past-due benefits and we will not control for cases that do not result in past-due benefits.

  • •

    After adjudicating the claim via MCS EC, on the following business day, the technician will add a special message to the record showing representative’s name and remark, "Case resulted in no past-due benefits, fee petition, fee paid by claimant."

NOTE 2: These instructions apply to Title II-only cases. For concurrent cases, code the "Fee Agreement Type" as "approved" unless past due benefits for Title XVI are known. If there are no past-due benefits for either Title II or Title XVI, code the "Fee Agreement Type" using the instructions above.

B. Disability Claims

Exclude disability insurance benefits claims, including widow(er)'s and child's insurance based on disability, from the non-medical completion process. Refer to DI 11010.115 for general information about non-medical completion. 

Non-medical completion exclusions are:

  • •

    Any claim involving a representative who is eligible for direct fee payment and who has not waived a fee.

  • •

    Any claim involving a representative who is not eligible for direct fee payment and has a fee agreement.

C. 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. Refer to GN 03920.035B. for policy on withholding from an auxiliary beneficiary.

When an auxiliary claim(s) is delayed and the amount of the fee based on the primary claimant and any non-delayed auxiliary is less than the statutory maximum indicated in GN 03940.003B.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 award(s). The fee authorization notice will advise the number holder and representative of the possibility that the fee may increase once we adjudicate any delayed auxiliary claim(s).

NOTE: If all 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 among all the auxiliaries. Refer to GN 03920.035B.2.b. for proration information. Refer to GN 03316.105 for important information regarding the limited information that may be disclosed to claimants about auxiliaries when sending notices. 

If the claimant filed concurrent Titles II and XVI claims before authorizing an additional fee based on benefits payable to any delayed auxiliaries, 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. We do 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. Auxiliary Claim(s) Delayed

If it is necessary to consider the delayed auxiliary claims in calculating and 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

  1. a. 

    Follow GN 03940.015A.2. or GN 03940.015A.3. when awarding benefits to the primary claimant and any non-delayed auxiliary beneficiary. Do not code the fee agreement as “undecided.”

  2. b. 

    Designate an incomplete notice if the case is processed with a manual award.

  3. c. 

    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 MS 03509.010)

2. Completing the Award or Disallowance for Any Auxiliary Beneficiary

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 any protected auxiliary beneficiary must agree with the number holder's LWD. Refer to MS 03509.009 . See GN 03920.035B. for policy on withholding from an auxiliary beneficiary.

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. Reconsideration Level

When the claimant files a request for reconsideration and has appointed a representative, and either one submits 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. 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 OHO Fee Contacts for Office of Hearings Operations routing contact information.

G. Post Entitlement Issues

The field office (FO) may receive a Form SSA-1696 (Claimant's Appointment of a Representative) and a fee agreement when the claimant is pursuing any type of benefit right(s), including post-entitlement or post-eligibility (PE) actions (e.g., suspension, overpayment, or appeal of disability cessation) that do not involve adjustment of benefit amounts to which entitlement or eligibility has already been established (e.g., workers' compensation offset).

1. Claims Specialist (CS) Makes Unfavorable Decision

Take no action under the fee agreement process for unfavorably decided PE issues.

2. CS Makes Favorable Decision

If you make a favorable decision on the PE issue, approve or disapprove the fee agreement. (Refer to GN 03940.003B.5. 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. To determine 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 appropriate systems or locate the notice of the fee authorization in ORS, eView, or Evidence Portal.

3. CS Does Not Make Decision

If you did not decide 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.

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203940015
GN 03940.015 - Title II - Field Office Processing of Fee Agreements - General - 12/18/2024
Batch run: 12/19/2024
Rev:12/18/2024