TN 3 (03-95)

GN 03960.035 PC Reviewer Responsibilities - Beginning Administrative Review of a Disapproval of the Fee Agreement

A. INTRODUCTION

Now that any necessary preliminary actions in GN 03960.020A.1. through A.3. are complete and you have received the request, it is time to begin administrative review.

B. PROCEDURE

Follow the steps below when reviewing a fee agreement disapproval determination.

1. Establish Authority to Review

Confirm that you have authority to act on the request for administrative review. (See GN 03960.005 for jurisdiction.)

Acknowledge receipt if you do not have jurisdiction, unless that has been done already under GN 03960.015, then refer the request to the correct office. (See model notices in GN 03960.075.)

Obtain the claim(s) file. Then proceed to 2. below.

2. Examine the Claim(s) File and the Request

  1. Identify:

    • all parties and the decision maker;

    • the fee agreement;

    • the Form SSA-553 (Special Determination) documenting the determination; and

    • the notice of the disapproval of the fee agreement.

  2. Screen the request for administrative review for:

    • timely filing;

    • filing by a proper party, i.e., a party who is affected by SSA's fee agreement disapproval (claimant or representative); and

    • the need for action on any other issue(s) the requester raised.

  3. Initiate any necessary development, by telephone or include your request for additional information in the letter described in 4. below, which acknowledges receipt of the request for administrative review. Ask for a response within 15 days and diary the case for 30 days.

  4. Proceed to 3. or 4. below.

3. Act on Late Filing With No Good Cause or Filing by Improper Party

If the request was not filed timely and the requester did not establish good cause (see GN 03960.025B.2.), or the request was not filed by a proper party:

  1. Follow GN 03960.070 to prepare the letter described below. Refer to GN 03960.085 for model final notices.

  2. Send a letter telling the requester:

    • the reason(s) for deciding that he/she did not show good cause, or he/she is not a proper party;

    • SSA will not review the determination; and

    • the representative must request approval of any fee he/she wants to charge and collect.

  3. Send a copy to the other party(ies).

  4. Enclose a Form SSA-1560-U4 with the letter or copy sent to the representative. Do not proceed with administrative review.

4. Provide Notice

  1. Follow GN 03960.070 to prepare the letters described below. Refer to GN 03960.075 for model letters.

  2. Prepare the letter telling the requester that you:

    • received his/her request;

    • are notifying the other party(ies) and the decision maker; and

    • will give them the opportunity to comment or submit additional information.

    If the requester filed timely or has established good cause for late filing, also explain what happens on review.

  3. Prepare the letter(s) informing the other party(ies) of the request for administrative review and what happens next. If the requester:

    • filed timely, explain to the other party(ies) what happens on review; and that he/she may, within 15 days, comment in writing and submit relevant information;

    • did not file timely but he/she has established good cause for late filing, briefly explain to the other party(ies) your finding; what happens on review; and that he/she may, within 15 days, comment in writing and submit relevant information;

    • did not file timely and you received an explanation but have not decided the good cause question in order to obtain further input as noted in GN 03960.025A.2.b., inform the other party(ies) of the requester's explanation for late filing; that they may, within 15 days, comment in writing and submit relevant information; and that they will hear from you after you have decided whether the requester has shown good cause; or

    • did not file timely and you are awaiting an explanation of the reason(s) for late filing, inform the other party(ies) that you are developing good cause; and they will hear from you again.

  4. Enclose a copy of the request for administrative review with the letter(s) to the other party(ies).

  5. Send the letters and enclosure(s). Send a copy to the decision maker. Diary the case for 30 days.

  6. When the diary matures, proceed to:

    • 5. below, if you are ready to act on the requester's explanation for late filing;

    • 6. below, if you need to follow-up for information you requested; or

    • GN 03960.037, if you are ready to complete administrative review.

5. Provide Subsequent Notice - Good Cause Question

  1. Follow GN 03960.070 to prepare the letter described in b. or c. below. Refer to GN 03960.080 for model letters.

  2. If the requester did not file timely and you received an explanation but have not decided the good cause question in order to obtain further input as noted in GN 03960.025A.2.b., prepare a letter informing the other party(ies) of the requester's explanation for late filing; that they may, within 15 days, comment in writing and submit relevant information; and that they will hear from you after you have decided whether the requester has established good cause. Proceed to d. below.

  3. Decide whether the requester has shown good cause for late filing. (See GN 03960.025B.2. for examples of good cause.) If the requester:

    • has not established good cause, go to 3. above.

    • has established good cause, prepare letters to the requester and the other party(ies) briefly explaining your finding; what happens on review; and that they may, within 15 days, comment in writing and submit relevant information.

  4. Send the letter(s) and a copy to the decision maker. Diary the case for 30 days.

  5. When the diary matures, proceed to:

    • c. above, if you have not yet decided the good cause question;

    • 3. above, if the requester has not established good cause for late filing;

    • 6. below, if you need to follow-up for information you requested; or

    • GN 03960.037, if you are ready to complete administrative review.

6. Follow-up for Outstanding Information

  1. Follow-up once by telephone or mail for any additional information you requested but have not received. Advise the party that if you do not receive it within 15 days, SSA will make its determination on the request for administrative review based on the information in file.

  2. Diary the case for 30 days.

  3. When you receive the information or the diary matures, proceed to:

    • 3. above, if the requester has not established good cause for late filing;

    • 5. above, if you are ready to act on the requester's explanation for late filing; or

    • GN 03960.037, if you are ready to complete administrative review.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203960035
GN 03960.035 - PC Reviewer Responsibilities - Beginning Administrative Review of a Disapproval of the Fee Agreement - 03/13/1995
Batch run: 01/27/2009
Rev:03/13/1995