BASIC (03-95)

GN 03950.040 Notice of the Administrative Review Decision (Step Five)

A. Policy - Notice of the Administrative Review Decision

SSA issues notice of the decision following administrative review in the form of a letter. The letter is addressed to the party who had requested review of the initial fee authorization. SSA sends copies of that letter to all other parties to the fee issue. This notice constitutes the formal and final decision of SSA. It cannot be further appealed in SSA or in the courts. As appropriate, the notice will reflect the signature of the Assistant Regional Commissioner for Management and Budget; the Director of the Office of Central Operations; or a designee, acting on his or her behalf.

1. Basic Contents of Notice

Every notice of the decision following administrative review must include the following basic information:

  • The authority under which the administrative review was conducted.

  • The fee evaluation criteria used. (Unless the criteria were given in the acknowledgment or interim letter.)

  • An explanation of how the services were evaluated in light of the seven evaluation factors (GN 03930.010).

  • A statement of whether the amount of the initial fee was affirmed or modified and SSA's reasons for doing so.

  • The amount of the fee SSA authorized on review.

  • An answer to all issues raised during the administrative review or a statement that the issue(s) is being considered and will be addressed at a later date (e.g., SSA failed to certify direct payment to an attorney of the initial authorized fee because SSA did not withhold past-due benefits or prematurely released them).

  • A discussion of the method of payment of the representative's fee (e.g., SSA will certify direct payment of all or a portion of the fee to the attorney representative; the claimant is responsible for payment of all or a portion of the representative's fee (however, if SSA previously released the remaining withheld past-due benefits after paying an attorney the initial authorized fee, advise the attorney to contact SSA if he or she is unable to collect the increased fee from the claimant); or the representative must refund to the claimant and the affected auxiliary beneficiary(ies), if appropriate, any excess amount previously certified or paid).

  • A statement that the Act and regulations do not provide for further review of the administrative review decision.

  • A statement that the other party(ies) (by name) will receive a copy of the administrative review decision letter.

  • A referral paragraph that includes the address and local telephone number of the servicing FO as well as "800" number information.

2. Use of Model Letters

Model notices are contained in GN 03950.065 for the purpose of example in explaining the process of administrative review. They must, however, be used with discretion. Representatives have generally more than one case before SSA, and each case is different. Sending stock notices, without individualized rationales, would give the appearance of a pro forma review, and could, especially in the legal community, create a question as to the integrity of the process of administrative review.

3. Copies Sent to Other Parties

Because of Privacy Act considerations, SSA will not reveal:

  • the claimant's mailing address when sending a copy of a letter addressed to the claimant, or the claimant's request for administrative review, to a party other than a representative; or

  • the auxiliary beneficiary's mailing address when sending a copy of a letter addressed to the beneficiary, or the beneficiary's request for administrative review, to a party other than a representative.

    NOTE: Representatives are bound by the regulations not to disclose any information we furnish or disclose about the claim or prospective claim of another person (see 20 CFR 404.1740(d) and 416.1520(d)).

This means the address must be covered before photocopying or completely blocked out before mailing.

B. Procedure - Notice of Administrative Review Decision

1. Preparation - Basic Contents of Notice(s)

Prepare notices as follows. State in:

  1. the opening paragraph the authority under which you are conducting administrative review. Indicate the basis for review (e.g., error of fact, error of law, or new information).

  2. the second paragraph, if the above basis for review exists, the fee evaluation criteria you used in reviewing the initial fee. This statement is