The following section provides models of the final letters described in GN 03950.040. Dictated letters will be prepared using these model letters as guides.

Because of Privacy Act considerations, we must not reveal:

• •

  The claimant's personal information (e.g., mailing address or Social Security number) when sending a copy of a letter addressed to the claimant, or the claimant's request for administrative review, to a party other than an individual representative; or

• •

  The auxiliary beneficiary's personal information when sending a copy of a letter addressed to the beneficiary, or the beneficiary's request for administrative review, to a party other than an individual representative.

This restriction means the personal information must be redacted before mailing.

 

AF-8 — Request for Administrative Review Denied - Good Cause Not Established

 

[Claimant's name]

Street Address

City/State/ZIP Code

 

On [date], you asked us to review the fee amount we said your representative, [representative’s name], can charge for work on your claim.

 

We asked you to explain why you did not ask us to review the fee amount within 30 days of our letter dated [date].

 

Our Decision About the Late Request

 

(This is an example scenario. Modify to fit the facts of your case as needed.) You said you did not get our notice of the fee amount until [date]. However, your local Social Security office says they talked to you about the fee notice on [date]. They told you then that you had to request review within 30 days of the date of our letter.

 

You asked for a review more than 30 days after the date of our letter. We decided that the reason you gave us does not show you had a good reason for missing the deadline.

 

Therefore, we will not review our final decision dated [date], about the fee amount.

 

We are sending copies of this letter to [the representative(s), any affected beneficiary’s or eligible spouses name(s)].

 

If You Have Any Questions

 

See Referral Paragraphs in Model Acknowledgment Letter AF-1

 

AF-9 — Final Letter - Fee Not Changed

 

[Representative’s name]

Attorney at Law (if applicable)

Street Address

City/State/ZIP Code

 

We are writing about your request to raise the fee amount we said you can charge for your work on [claimant’s name]'s claims.

 

The law allows us to approve a representative's fee for Social Security claims-related services. The law also allows us to review decisions about the fee for those services.

 

When we authorize a representative's fee, we consider the purposes of the Social Security and Supplemental Security Income (SSI) programs. In all cases, we also consider:

• •

  The services provided (including the type of service);

• •

  The difficulty of the case;

• •

  The level of skill required to provide the services;

• •

  The amount of time spent on the case;

• •

  The results achieved;

• •

  The level of administrative review to which the representative took the claim;

• •

  The level of review at which they entered the proceedings; and

• •

  The fee amount requested, not including any out-of-pocket expenses, but including any amount already approved or requested. An example of out-of-pocket expenses is the cost to get copies of doctors' or hospitals' reports.

   

We do not authorize a representative's fee on a straight hourly basis or as a percentage of any past or future benefits.

 

Our Determination

 

Someone who did not make the first determination reviewed the fee amount. We considered the above factors and your letter dated [date], in making our decision. Based on this review, we decided that the [initial authorized amount] we approved before is reasonable for your services.

 

(Response to specific issue(s) or argument(s) raised.)

 

The amount indicated above is the most you can charge for your work on [claimant's name]'s Social Security and SSI claims. We did not change the fee amount because (Rationale for not modifying the fee.)

 

There is no further review available. The legal references for this are 20 CFR 404.1720(d)(1) and 416.1520(d)(1).

 

We are sending copies of this letter to [all proper parties’ names].

 

If You Have Any Questions

 

See Referral Paragraphs in Model Acknowledgment Letter AF-1

 

AF-10 — Final Letter - Fee Raised

 

[Representative’s name]

Attorney at Law (if applicable)

Street Address

City/State/ZIP Code

 

We are writing about your request to raise the fee amount we said you can charge for your work on [claimant’s name]'s claims.

 

The law allows us to approve a representative's fee for Social Security claims-related services. The law also allows us to review decisions about the fee for those services.

 

Our Determination

 

Someone who did not make the first determination reviewed the fee amount. In our letter dated [date], we told you about the factors we consider in approving a representative's fee. We considered those factors, your letter dated [date], and [claimant’s name]'s letter dated [date], in making our decision. Based on this review, we decided that you may charge [revised fee amount]. We raised the fee amount because [rationale for increasing the fee, include a response to specific issue(s) and argument(s) raised]. The fee does not include any out-of-pocket expenses (for example, costs to get copies of doctors' or hospitals' reports).

 

This determination replaces our earlier one about the fee amount dated [date]. This new amount is the most you can charge for your work on [claimant’s name]'s Social Security and Supplemental Security Income (SSI) claims.

 

(This is an example scenario. Modify to fit the facts of your case as needed, e.g., we will directly pay a portion of the revised fee authorized, subject to the 25 percent withholding maximum.) We paid you [amount withheld and paid directly] from [claimant’s name]'s past-due benefits. This amount is 25 percent of [claimant’s name]'s Social Security (an/or SSI) past-due benefits. Payment of the rest of the fee is a matter between you and [claimant's name].

 

There is no further review available this matter. The legal references for this are 20 CFR 404.1720(d)(1) and 416.1520(d)(1).

 

We are sending a copy of this letter to [claimant’s name].

 

If You Have Any Questions

 

See Referral Paragraphs in Model Acknowledgment Letter AF-1

 

AF-11 — Final Letter - Fee Lowered

 

[Claimant’s name]

Street Address

City/State/ZIP Code

 

We are writing about your request to lower the fee amount we said your representative, Susan Jones, can charge for their work on your claim.

 

The law allows us to approve a representative's fee for Social Security claims-related services. The law also allows us to review decisions about the fee for those services.

 

When we authorize a representative's fee we consider the purpose of the Social Security program(s). We also consider:

• •

  The services provided (including the type of service);

• •

  The difficulty of the case;

• •

  The level of skill required to provide the services;

• •

  The amount of time spent on the case;

• •

  The results achieved;

• •

  The level of administrative review to which the representative took the claim;

• •

  The level of review at which the representative entered the proceedings; and

• •

  The amount of the fee requested, not including any out-of-pocket expenses but including any amount already approved or requested. An example of out-of-pocket expenses is the cost to get copies of medical records.

   

We do not approve a representative's fee on a straight hourly basis or as a percentage of any past or future benefits.

 

Our Determination

 

Someone who did not make the first determination  reviewed the fee amount. We considered the above factors and your letter dated [date], in making our determination . Based on this review, we decided that your representative may charge [revised fee authorization amount]. We lowered the fee amount because [rationale for decreasing the fee, include a response to specific issue(s) and argument(s) raised]. The fee does not include any out-of-pocket expenses.

 

This determination replaces our earlier one about the fee amount dated [date]. Your lawyer can collect the fee as follows:

 

We paid your representative (or entity's name) $[initial fee authorization amount] from your and your children's (if applicable) past-due benefits. The fee amount we now approve is $[difference between initial and revised fee authorization amounts] less than we paid. Your representative (or entity's name) must refund $[difference between initial and revised fee authorization amounts] to us. We will also pay you and your children (if applicable) the additional past-due benefits we withheld, which will total $[difference between initial and revised fee authorization amounts].

 

There is no further review available in this matter. The legal authority for the finality of this decision is [20 CFR 404.1720(d)(1) and/or 416.1520(d)(1)].

 

We are sending copies of this letter to [representative’s name] and [auxiliary beneficiary name 1, if applicable] and [parent or legal guardian’s name, if applicable] for [auxiliary beneficiary name 2, if applicable].

 

If You Have Any Questions

 

See Referral Paragraphs in Model Acknowledgment Letter AF-1