Effective Dates: 12/09/2024 - Present Previous | Next

TN 50 (12-24)

GN 03940.050 Title XVI - Field Office Processing of Fee Agreements on Favorably Decided Concurrent Title II and Title XVI Claims

A. Procedure – General

1. Preliminary Steps

Before proceeding to the steps in GN 03940.050B, ensure that all the following events have occurred:

  • •

    The representative information is correctly posted to the Supplemental Security Record (SSR) using the Direct SSR Authorized Representative (UATH) screen, and the Representative Fee Update Data (UFEE) screen (MSOM BUSSR 002.013, and MSOM BUSSR 002.014, respectively).

  • •

    The Title XVI claim was paid.

  • •

    The decision maker (see GN 03940.002) approved the fee agreement.

  • •

    The claimant, if mentally incapable, has a payee.

  • •

    The Title XVI CS knows the amount of the Title II portion of the fee.

2. Fee Agreement Determination Pending

If the claim was decided at the initial or reconsideration level and the Title II decision maker has not yet made a determination on the fee agreement, diary the claim for 45 days for the fee agreement determination.

Do not delay effectuating payment. Code the Fee Situation on the UFEE screen as “1 = Unresolved Fee Agreement.” (See MSOM BUSSR 002.014)

NOTE: The system automatically withholds 25 percent of the Title XVI past-due benefits or the remaining past-due benefits if that amount is less than 25 percent after we make any interim assistance reimbursement (IAR). This amount is withheld for direct payment of authorized 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 must be recalculated for representative fee purposes to consider Title II benefits due for the same period. To ensure that direct payment of an authorized fee does not exceed 25 percent of past-due benefits in a concurrent claim situation, calculate the Title XVI past-due benefits for representative fee purposes as if the Title II benefits had been timely, per 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 authorized fees and collecting overpayments. This payment is subject to dedicated account and installment payment provisions – see SI 02101.010 and SI 02101.020.

3. Fee Agreement Approved

If the Title II CS or OHO or OAO decision makers approved the fee agreement, and the approval appears correct, determine whether you have information regarding the Title II fee amount. Go to GN 03940.050A.4 Title II Fee Amount Unknown, or GN 03940.050B Procedure - Title II Fee Amount Known, as appropriate.

4. Title II Fee Amount Unknown

If the Title II portion of the fee, including the auxiliary beneficiary's amount is unknown:

  • •

    Leave the fee unresolved and diary the claim for 45 days; and

  • •

    Send an interim notice advising the claimant and representative that we are deferring the fee amount determination until we complete the pending Title II claim, and that upon completing the Title II claim actions, we will send another notice advising them of the fee authorized under Title XVI.

NOTE 1: An automated fee notice is produced explaining the situation if:

  • •

    The Fee Status is resolved on the UFEE screen (see MSOM BUSSR 002.014),

  • •

    The SSR reflects a field office (FO), Office of Hearings Operations (OHO), or Office of Appellate Operations (OAO) approval of the fee agreement, and

  • •

    The Title II portion of the fee is unknown.

If there are multiple representatives, and at least one did not assign direct payment of their fee to an entity or all did not assign to the same entity, prepare a manual notice. However, if there are multiple representatives who have all assigned direct payment of their fee to the same entity, the notice and payment is automated.  

NOTE 2: Do not send copies of these notices or other protected information (e.g., claimant information) to the entity’s point of contact (POC) if there a valid assignment unless the information included is the minimum amount of information necessary for the POC to review to resolve fee-related issues. For information that is not relevant or necessary to resolving fee-related issues. For information that is not relevant or necessary to reslove fee-related issues, only disclose such information if the claimant has expressly consented on a Form SSA-3288 or other written consent that meets the requirements of GN 03305.003. For information on assignment of direct payment fees, including the roles and responsibilities of a POC, see GN 03920.021.

NOTE 3: If the claim for the primary Title II beneficiary has been processed, the authorized Title II fee is less than the specified dollar amount of the fee cap as indicated in GN 03940.003B.3 (or any lower maximum fee specified in the fee agreement), and there is an auxiliary claim pending that would involve past-due benefits on which to base an additional Title II fee amount, leave the FEE SITUATION on the Representative Fee Update Data (UFEE) screen as "UNRESOLVED." Although this action will create a 2L diary, it will prevent the system from prematurely computing an incorrect Title XVI fee amount. When you know the amount of the Title II portion of the fee, including any auxiliary beneficiary’s amount proceed to GN 03940.050B.

NOTE 4: The system automatically withholds 25 percent of the Title XVI past-due benefits or the remaining past-due benefits if that amount is less than 25 percent after SSA makes any interim assistance reimbursement. This amount is withheld for direct payment of authorized 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 is prior to offset of the Title XVI past-due benefits. To ensure that direct payment of an authorized fee does not exceed 25 percent of past-due benefits in a concurrent claim situation, offset the Title XVI past-due benefit per 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 authorized fees. This payment is subject to dedicated account and installment payment provisions – see SI 02101.010 and SI 02101.020. 

B. Title II Fee Amount Known

1. Automated Processing

The authorized fee is the combined total of the Title II portion of the fee (i.e., wage earner's and any auxiliary beneficiary’s), and the Title XVI portion of the fee. Title II offset is always applied, unless Title XVI is not payable in the offset period per GN 02610.018. Thus, if the Title II claim is effectuated first (i.e., Title II continuing monthly benefits are paid first), all retroactive Title II benefits are still withheld until Title XVI has been paid and the Title II offset amount is determined.

In most concurrent fee agreement cases, FOs can make inputs to the SSR that will trigger the automated computation of the Title XVI fee and issuance of a fee notice to the claimant and representative. Also, when there are past-due benefits available for direct payment and the representative has not waived a fee and is eligible for direct payment, in many fee agreement cases the SSR will compute the fee assessment and trigger direct payment to the representative or the eligible entity if there is a valid assignment.

2. Manual Processing

To determine whether a case is excluded from automated processing, refer to GN 03940.050C. Once you determine that the case is excluded from the automated processing, use the following steps to process the fee agreement in concurrent Title II and Title XVI claims:

a. Step 1

If the Title II portion of the fee equals the specified dollar amount in the fee agreement or the fee cap as indicated in GN 03940.003B.3, go to GN 03940.050B.2.e (Step 5); otherwise, go to GN 03940.050B.2.b (Step 2).

b. Step 2

To determine the maximum amount you can approve for the Title XVI portion of the fee, subtract the Title II portion of the fee amount from the applicable specified dollar amount of the fee cap as indicated in GN 03940.003B.3, or the maximum fee specified in the fee agreement. Go to GN 03940.050B.2.c (Step 3).

c. Step 3

To determine the amount of Title XVI retroactive payment that is the past-due benefit amount for fee purposes (see GN 03940.007B), examine the payment history (PMTH segment), underpayment information (MPMT segment), and computation history (CMPH segment) on the SSID. Reduce the Title XVI retroactive payment amount by any benefits and/or payments that are not considered past-due benefits for representative fee purposes (see GN 03920.031C) and by the Title II offset amounts for months in the past-due period for representative fee purposes (i.e., we reduce the Title XVI retro by the amount of Title XVI that would not have been paid if the Title II benefits had been paid timely). The result is the Title XVI past-due benefits amount for representative fee purposes. Go to GN 03940.050B.2.d (Step 4).

NOTE: Limit the Title II offset amount to the months that are part of the past-due benefit period for representative fee purposes (e.g., when adjudication of the Title II claim is delayed and the offset period extends beyond the month we effectuate the Title XVI favorable decision made at or below the Appeals Council level).

d. Step 4

If the result at GN 03940.050B.2.c (Step 3) equals zero, go to GN 03940.050B.2.e (Step 5). If the result is greater than zero, authorize a fee that equals the least of:

  • •

    25 percent of the Title XVI past-due benefits; or

  • •

    the percentage of past-due benefits or the flat fee amount specified in the agreement; or

  • •

    the figure derived at GN 03940.050B.2.b (Step 2).

Enter the total fee (Title XVI fee plus Title II fee) on the UFEE screen in the TXVI and/or TII Manual Fee Agreement Amount block.

e. Step 5

If the representative has not waived a fee and is eligible for direct payment or there is an entity with a valid assignment, follow the procedures in GN 03940.050C.

f. Step 6

If the notice is not automated, prepare a Title XVI fee agreement notice (see GN 03940.055 and GN 03940.070).

If you are the decision maker and believe a request for administrative review of the authorized fee is appropriate (see GN 03940.001E), you must file the request within 15 days of the date of the notice.

g. Step 7

When performing the Title II windfall or “real” offset computation, subtract the total authorized representative fees for both titles from the retroactive Title II benefits per SI 02006.203.

C. Manual Processing When Representative or Entity Is Eligible for Direct Payment

1. General

In most concurrent Title II and Title XVI cases, the computations and notices for initial claims involving a fee agreement and direct payment of the authorized fee are fully automated.

The fee calculation and direct payment of an approved fee are not fully automated in the following situations:

  • •

    There is a prior overpayment (i.e., overpayment for a period outside the award period) that is greater than 75 percent of past-due benefits. (See GN 03940.050C.2)

  • •

    Interim assistance reimbursement (IAR) cases with an overpayment for a prior period of eligibility where the sum of the IAR payment and the overpayment is greater than 75 percent of past-due benefits. (See GN 03940.050C.2)

  • •

    The claimant has multiple representatives, unless all representatives have assigned direct payment of their fee to the same entity. (See GN 03920.050D.2);

  • •

    An eligible spouse's past-due benefits are included in authorizing the claimant's representative's fee. (See GN 03940.052); or

  • •

    Start dated records (regardless if the start date month is earlier or later than the beginning of the past-due period subject to fees), force pay records, force due records, and post eligibility cases (i.e., disability cessation appeals).

After determining the Title XVI portion of the fee to authorize based on the Title XVI past-due benefits, in conjunction with the Title II fee, follow the procedures in GN 03940.050.C.2 or 3 to make direct fee payment in the above situations.

NOTE: Concurrent cases which involve representative fees from Title II auxiliaries may now be automated. However, technicians must ensure that the correct total representative fee from the Title II past due benefits has posted to the SSR before automating.

2. Prior Overpayment

Refer to identified section of SM 01901.950C.4 for procedures in these situations:

CASE SITUATION

REFERENCE

Prior overpayment, IAR involved

SM 01901.950C.4.b

Prior overpayment, No IAR involved

SM 01901.950C.4.e

In addition, if the claim also involves another exception to automated process listed in GN 03940.050C.1, refer to the procedures in GN 03940.050C.3.

3. Manual Processing Steps

Follow either of the next two subsections, when it is necessary to manually calculate the Title XVI fee amount, and the representative, or entity if there is a valid assignment, is eligible for direct fee payment. If the Title II fee is equal to or greater than the applicable specified dollar amount of the fee cap as indicated in GN 03940.003B.3 (or the maximum fee based on the fee agreement), go to GN 03940.050C.3.a. If the Title II fee is less than the specified dollar amount of the fee cap (or maximum fee based on the fee agreement), go to GN 03940.050C.3.b.

a. Title II Fee Equal to the Maximum Specified Dollar Amount of the Fee Cap (or Maximum Fee Based on the Fee Agreement)

NOTE: "Title II fee equal to the maximum specified dollar amount of the fee cap (or the maximum fee under the fee agreement)" refers to the total fee amount approved based on the Title II wage earner's and any auxiliary's past-due benefits.

STEP ACTION NOTES

1

Because the Title II fee is the maximum allowed under the fee agreement, the Title XVI fee is 0.

 

2

If the Title II fee has been posted to the SSR, post the automated fee information to the SSR via UFEE using a Fee Status of 1 or 2 (fee agreement approved by FO or HO or OAO decision maker), and an Involved Claim Type of 1 (Concurrent).

NOTE: The system will determine that no additional fee is due and process the remainder of the actions necessary, including issuing an automated notice.

 

3

If the Title II fee has not been posted to the SSR, post the manual fee information to the SSR via UFEE using a Fee Status of 8 (manually computed fee agreement) and Involved Claim Type of 1 (Concurrent), and the approved Manual Fee Agreement Amount.

Issue a manual notice to explain that we cannot approve a Title XVI fee in addition to the approved maximum Title II fee that has been paid.

 

b. Title II Fee Is Less Than the Maximum Specified Dollar Amount of the Fee Cap (or Maximum Fee Based on the Fee Agreement)

STEP ACTION NOTES

1

Determine the SSI retroactive benefits amount.

 

2

Calculate the Title XVI past-due benefits for fee purposes and the Title XVI fee. In calculating the Title XVI fee, consider the Title II fee amount (i.e., the combined Title XVI and Title II fee cannot be greater than the current statutory fee cap (see GN 03940.003B.3)).

See GN 03920.031.

   

See GN 03940.050B.

   

3

Determine the amount available to pay by OTP to the representative as follows:

   SSI retroactive benefit amount (from Step 1)

  • –

    IAR amount, if any

    Difference (amount available to pay by OTP to the representative)

 

4

Determine the amount to pay by OTP to the representative and the assessment, if any, as follows:

Compare the Title XVI fee (Step 2) with the amount available (Step 3).

  • –

    If Title XVI fee is greater than the amount available, use the amount available (Step 3) to calculate any assessment and the amount to pay the representative or entity by OTP (amount available minus the user fee).

  • –

    If Title XVI fee is equal to or less than the amount available, use the Title XVI fee amount (Step 2) to calculate any assessment and the amount to pay the representative by OTP (fee – assessment).

See GN 03920.016D for a list of factors that impact the amount we will directly pay.

   

See GN 03920.019 Assessment on Representatives Who Receive Direct Payment

   

See GN 03920.025 if the claimant deposited money in an escrow account.

5

Determine the amount to pay by OTP to the claimant as follows:

    SSI past-due benefit amount (from Step 1)

  • –

    Minus the IAR amount, if any

  • –

    Minus the amount used to collect any user fee and pay the representative or entity by OTP (Step 4)

  • –

    Minus prior collectible overpayment, if any

    Difference (amount to pay by OTP to the claimant)

Consider installment/dedicated account provisions. See SI 02101.020 and SI 02101.010.

  

See GN 03920.033 Representative’s Fee – Title XVI Past-Due Benefit Payable

6

Issue the OTP for any IAR

 

7

The following day, post the manual fee information to the SSR via UFEE using a FEE STATUS = 8 and the total of the Title XVI fee (Step 2) and the Title II fee. The SSR will display FST = M and FMA = the total of the Title XVI and Title II fees.

 

8

On the UPOF screen, issue the OTP to the representative or entity in the amount found in Step 4 and post user fee, if any.

 

9

Issue a manual fee notice

See GN 03940.008, GN 03940.055 and GN 03940.070.

Refer to SM 01901.950 One Time Payment (OTP) Processing for Direct Payment for Manual Fee Agreements and Fee Petitions for of Appointed Representatives.

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203940050
GN 03940.050 - Title XVI - Field Office Processing of Fee Agreements on Favorably Decided Concurrent Title II and Title XVI Claims - 12/09/2024
Batch run: 12/18/2024
Rev:12/09/2024