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

 

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

 

George Bailey
Street Address
City/State/ZIP Code

 

On June 20, 1995, you asked us to review the fee amount we said your representative, Jane Doe, can charge for her 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 April 15, 1995.

 

Our Decision About The Late Request

 

You said you did not get our notice of the fee amount until May 30, 1995. However, your local Social Security office says they talked to you about the fee notice on April 28, 1995. 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 daysafter 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.

 

So we will not review our final decision dated April 15, 1995, about the fee amount.

 

We are sending copies of this letter to Jane Doe, Mary Bailey, and Zuzu Bailey.

 

If You Have Any Questions

 

See Referral Paragraphs in Model Acknowledgment Letter AF-1

 

AF-9 — Final Letter - Fee Not Changed

 

Jane Doe
Attorney at Law
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 Sally Brown'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 approve 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 he or she 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 approve a representative's fee on a straight hourly basis or as a percentage of any past or future benefits.

 

Our Decision

 

Someone who did not make the first decision reviewed the fee amount. We considered the above rules and your letter dated July 15, 1995, in making our decision. Based on this review, we decided that $1,500 we approved before is reasonable for your services.

 

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

 

This is the most you can charge for your work on Ms. Brown'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 to you, to Ms. Brown, or to her children in this matter. 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 Ms. Brown, Susy Brown, and Joey Brown.

 

If You Have Any Questions

 

See Referral Paragraphs in Model Acknowledgment Letter AF-1

 

AF-10 — Final Letter - Fee Raised

 

John Jones
Attorney at Law
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 James Smith's claims.

 

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

 

Our Decision

 

Someone who did not make the first decision reviewed the fee amount. In our letter dated August 12, 1995, we told you about the rules we consider in approving a representative's fee. We considered those rules, your letter dated July 15, 1995, and Mr. Smith's letter dated August 28, 1995, in making our decision. Based on this reivew, we decided that you may charge $2,000. 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 decision replaces our earlier one about the fee amount dated February 15, 1995. This new amount is the most you can charge for your work on Mr. Smith's Social Security and Supplemental Security Income claims.

 

We paid you $1,500 from Mr. Smith's past-due benefits. This amount is 25 percent of Mr. Smith's Social Security past-due benefits. Payment of the rest of the fee is a matter between you and Mr. Smith.

 

There is no further review available to you or to Mr. Smith in 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 Mr. Smith.

 

If You Have Any Questions

 

See Referral Paragraphs in Model Acknowledgment Letter AF-1

 

AF-11 — Final Letter - Fee Lowered

 

Emily Harris
Street Address
City/State/ZIP Code

 

We are writing about your request to lower the fee amount we said your lawyer, Susan Jones, can charge for her 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 approve a representative's fee we consider the purpose of the Social Security program. 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 he or she 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 doctors' or hospitals' reports.

   

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

 

Our Decision

 

Someone who did not make the first decision reviewed the fee agreement. We considered the above rules and your letter dated July 15, 1995, in making our decision. Based on this review, we decided that your lawyer may charge $1,000. 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 decision replaces our earlier one about the fee amount dated February 15, 1995. Your lawyer can collect the fee as follows:

 

We paid your lawyer $1,500 from your and your children's past-due benefits. The fee amount we now approve is $500 less than we paid. Your lawyer must refund $500. If you do not receive a refund soon, let us know.

 

There is no further review available to you, to your children, or to Ms. Jones in this matter. The legal reference to this is 20 CFR 404.1720(d)(1).

 

We are sending copies of this letter to Ms. Jones and Mr. George Harris for Susy Harris and Joey Harris.

 

If You Have Any Questions

 

See Referral Paragraphs in Model Acknowledgment Letter AF-1