TN 17 (03-05)

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

A. Policy

When SSA issues a decision favorable to the claimant, SSA will approve a fee agreement that meets the statutory requirements of the Act and is not otherwise excepted, even if the claimant's mental capability (i.e., the claimant's ability to manage his/her funds) is at issue.

In these situations, SSA defers authorizing a fee until resolving the capability issue and, if appropriate, until selecting a representative payee for the claimant. This 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 his/her representative payee.

SSA assigns high priority to claims requiring a determination of mental capability and selection of a representative payee. SSA should decide most cases when it issues the notice of favorable decision; therefore, this policy will not unduly delay the fee authorization.

B. Procedure

1. Claims Representative (CR) Actions - Development Incomplete

If the issues of mental capability and/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 and/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, Fee Agreement Evaluation).

    EXCEPTION: Do not approve the fee agreement for claims already decided by the title II CR 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 SSID. On the UFEE screen (see MSOM BUSSR 002.014), for the FEE SITUATION field, select ‘1,” Unresolved Fee Agreement/Petition. If the representative is eligible for direct payment, make sure direct payment is indicated on the supplemental security record (SSR).

  • Prepare a manual notice advising the parties that you will defer authorizing a fee under the fee agreement process pending resolution of the capability issue. If the representative is eligible for direct payment, also advise that you are withholding past-due benefits for possible direct payment to the representative.

2. CR 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 claimant, if capable or, if incapable, his/her representative payee and the representative) 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, and include direct payment information in the fee notice.

  • Notify the decision maker of the authorized fee by e-mail, if the decision maker has requested notification.

    NOTE: The 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.


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http://policy.ssa.gov/poms.nsf/lnx/0203940051