Process the fee agreement based on the known past-due benefits at the time of the award.

1. a. 

   Calculate the fee amount using the primary claimant's and any non-delayed auxiliary beneficiary's past-due benefits amount(s) (see GN 03940.020).

2. b. 

   Record the fee amount in the claim(s) file.

3. c. 

   Review the Representative Appointment, Services, and Registration (RASR) application to determine if the representative is eligible for direct fee payment. See GN 03940.020E.1. for guidance in interpreting the entry.

4. d. 

   Enter information via the APPREP/APPFEE data (ARA/ARB screens) and withhold via the AD special entry on the MACADE history screen for initial claims and post-entitlement or eligibility actions. This data passes to the attorney fee data line of the Master Beneficiary Record (MBR).

5. e. 

   Annotate the MBR Special Message field that an additional fee may be authorized when the auxiliary claim(s) is adjudicated (see MS 06307.008).

6. f. 

   Prepare a notice with the appropriate fee agreement paragraphs. Replace the fee agreement amount paragraph, as the case requires. These are the MADCAP and MCS paragraphs for delayed auxiliary claims:

   • •

     ATYR20: Fee amount Title II claim only - NH only – delayed auxiliary claim(s) pending or expected - NH's award notice

   • •

     ATYR22: Fee amount Title II claim - only NH and any non-delayed auxiliary beneficiaries - delayed auxiliary claim(s) pending or expected - NH's award notice

   • •

     ATYR24: Fee amount concurrent Title II and Title XVI claims offset information pending – NH only – delayed auxiliary claims pending or expected - NH's award notice

   • •

     ATYR26: Fee amount concurrent Title II and Title XVI claims - offset information pending - NH and non-delayed auxiliary beneficiaries - delayed auxiliary claims pending or expected - NH's award notice

   Refer to NL 00725.005 for MCS paragraphs. Also refer to GN 03940.080, Fee Agreement Process – Title II – Delayed Auxiliary Claim(s) Paragraphs.

7. g. 

   Send the notice(s) to the claimant, any non-delayed auxiliary beneficiary, and a copy to the representative. Refer to GN 03316.110 for instructions on disclosure to auxiliary claimants and beneficiaries about a primary claimant and to GN 03316.105 for instructions on disclosure without consent to a primary claimant about an auxiliary filing on their record. Also send an e-mail message to the Office of Hearings Operations (OHO) or Office of Appellate Operations (OAO) decision maker to notify the decision maker of the authorized fee amount and that a copy of the award letter is available in the Online Retrieval System (ORS), if the decision maker requested to be notified. Use the global address list in outlook to locate the decision maker’s email address.

   NOTE: To request the notification for the purpose of possibly requesting administrative review, the OHO or OAO decision maker will flag the claim and provide an e-mail address to which to send the notification. Refer to Hearings, Appeals, and Litigation (HALLEX) manual I-1-2-45 for the initial procedures an OHO or OAO decision maker will follow to request administrative review of the fee amount.

8. h. 

   Withhold 25 percent of past-due benefits or the amount of the authorized fee, if known, when the representative has not waived their fee or direct payment of the fee and is eligible for direct payment. Withhold 25 percent if there is Federal court involvement.

9. i. 

   Certify direct payment to the representative who is eligible for direct payment or to an eligible entity if there is a valid assignment if no one has requested administrative review (or once we complete the review if one was requested). See GN 03920.016B. for more information about eligibility for direct payment. 

After we adjudicate the delayed auxiliary claim(s), take the following actions:

1. a. 

   Authorize a fee based on any auxiliary's past-due benefits. However, to ensure we do not authorize a fee in excess of the statutory maximum indicated in GN 03940.003B.3 (or any lower maximum fee specified in the fee agreement) consider the fee amount already authorized based on the primary claimant's and any non-delayed auxiliary beneficiaries' Title II past-due benefits. Also, as stated in GN 03940.015C., in concurrent cases check to ensure that a Title XVI fee amount was not inadvertently authorized early (i.e., before the entire Title II fee amount was known). If a Title XVI fee amount was inadvertently authorized early, also consider that amount in determining how much has been authorized toward the statutory maximum indicated in GN 03940.003B.3 (or any lower maximum fee specified in the fee agreement). The amount of the Title XVI fee is recorded in the T16$ field on the AUTH segment of the Supplemental Security Record (SSR). If direct payment was made, the Title XVI amount passes to the Single Payment System (SPS).

   Refer to GN 03920.035 for withholding and proration policy and procedures.

   NOTE: The fee authorization based on any delayed auxiliary beneficiary’s past-due benefits is a reopening of the initial fee authorization. We are not establishing a new fee event. The primary claimant and any auxiliary beneficiaries are bound by the primary claimant’s fee agreement. Technicians must update the APPREP field on the MBR for the primary claimant to reflect the updated past-due benefits total for all individuals bound by the primary claimant’s fee agreement. 

2. b. 

   When the representative is eligible for direct payment and the amount withheld from the primary claimant's past-due Title II benefits (or, in concurrent cases, Title XVI benefits) was less than the maximum fee amount provided in the approved fee agreement, withhold 25 percent of any auxiliary beneficiary’s past-due benefits or the amount of the authorized fee, if known, towards direct payment. If there is Federal court involvement, withhold 25 percent of any auxiliary beneficiary’s past-due benefits.

3. c. 

   Prepare a notice with the appropriate fee agreement paragraphs.

4. d. 

   Send the notice to any auxiliary beneficiary and a copy to the representative. If the claim is flagged, also send an e-mail message about the fee authorization to the OHO or OAO decision maker.

5. e. 

   If the representative is eligible for direct payment and has not waived a fee or direct payment or there is an eligible entity with a valid assignment, certify direct payment to the representative or to the entity if no one has requested administrative review (or once we complete the review, if one was requested).

6. f. 

   If all auxiliary beneficiaries are not members of the same household, adjust any non-delayed auxiliary beneficiary's benefits based on the proration of the fee amount.

7. g. 

   Disburse any remaining past-due benefits withheld to the claimant and any auxiliary beneficiary unless there is Federal court involvement. For any auxiliary beneficiaries that are not a member of the same household as the claimant, follow the steps in GN 03930.070B to determine how to release the remaining past-due benefits.

8. h. 

   Notify the primary claimant and all auxiliary beneficiaries of your proration action.