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

TN 51 (12-24)

GN 03940.051 Field Office Processing of Fee Agreements in Title XVI or Concurrent Titles II and XVI Claims Involving Mental Capability

A. Policy

When we issue a determination or decision (hereinafter "decision") favorable to the claimant, we will approve a fee agreement that meets the statutory requirements of the Social Security Act and that is not otherwise excepted, even if the claimant's mental capability (i.e., the claimant's ability to manage their funds) is at issue.

In these situations, we defer authorizing a fee until resolving the capability issue and, if appropriate, until we select a representative payee for the claimant. This deferral allows us to keep a substantial number of fee agreements in the fee agreement process but protects a potentially incapable claimant's right to request administrative review of a fee by sending notice of the fee amount and of the right to request administrative review to the claimant's representative payee.

We assign high priority to claims requiring a determination of mental capability and selection of a representative payee. Generally, these issues will have been decided when we issue the notice of favorable decision; therefore, this policy will generally not unduly delay the fee authorization.

B. Procedure

1. Claims Specialist (CS) Actions — Development Incomplete

If the issues of mental capability or payee development are pending when you effectuate the favorable decision and you are paying the claimant current benefits directly pending resolution of the capability issue or representative payee selection, take these actions:

  • •

    Review the fee agreement to determine that it meets the statutory requirements of the Act for approval and is not otherwise excepted (see GN 03940.003).

    EXCEPTION: Do not approve the fee agreement for claims already decided by the Title II CS or decided at the hearing or Appeals Council review level. You are not the decision maker at these levels.

  • •

    Document your determination on a Form SSA-553 (Special Determination).

  • •

    Complete the representative data in the “AUTH Segment” on the supplemental security record (SSR). On the UFEE screen (see MS 00302.014), for the FEE SITUATION field, select "1,” Unresolved Fee Agreement/Petition. If the representative has not waived a fee and is eligible for direct payment, make sure direct payment is indicated on the SSR.

  • •

    Prepare a manual notice advising the parties that you will defer authorizing a fee under the fee agreement process until after resolution of the capability issue. If the representative has not waived a fee and is eligible for direct payment or there is an entity with a valid assignment, also advise that you are withholding past-due benefits for possible direct payment to the representative or to the entity.

NOTE: An entity is not a party to the fee agreement (see GN 03940.003B.2 and GN 03960.001D.5) and will generally not need to receive a copy of this notice. If there is a valid assignment of direct payment of a representative’s fee to an entity, the entity’s point of contact (POC) may need to review fee-related information to resolve fee-related issues. However, do not send a copy of the award notice or other protected information (e.g. claimant information) to the entity’s POC unless it is the minimum amount of information necessary for the POC to review it to resolve fee-related issues. Only disclose information that is not relevant or necessary to resolve fee-related issues 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 of fees, including the roles and responsibilities of a POC, see GN 03920.021.

2. CS Actions — Development Complete

If you have resolved the issues of mental capability and selection of a representative payee, take these actions:

  • •

    Change the FEE SITUATION status to “2,” “Resolved Fee Agreement.”

  • •

    Authorize a fee under the fee agreement process following the instructions in GN 03940.046A for Title XVI only claims and GN 03940.050C in concurrent claims.

  • •

    When the fee is computed, the system will issue a notice advising the parties (i.e., the representative and the claimant,) of the authorized fee and of the right to request administrative review. The system will also make direct payment to the representative, if the representative is eligible for direct payment, or to the eligible entity if there is a valid assignment, and include direct payment information in the fee notice.

  • •

    Notify the decision maker of the authorized fee by email, if the decision maker has requested notification.

    NOTE: The Supplemental Security Income (SSI) automated notice system will send a copy of the notice to the decision maker if the notice is automated.

C. Reference

For representative payee selection, see GN 00500.000.

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203940051
GN 03940.051 - Field Office Processing of Fee Agreements in Title XVI or Concurrent Titles II and XVI Claims Involving Mental Capability - 12/18/2024
Batch run: 12/18/2024
Rev:12/18/2024