TN 3 (03-95)
GN 03960.037 PC Reviewer Responsibilities - Completing Administrative Review of a Disapproval of the Fee Agreement
It is time to complete your review, if you have:
decided that the requester, if he/she filed late, has shown good cause; and
given the other party(ies) the opportunity to respond to the request for administrative review.
1. Review the Fee Agreement Disapproval
In reviewing the fee agreement disapproval consider if:
conditions for approving the fee agreement were met at the time the decision maker made the favorable determination on the claim or PE action (GN 03940.001C.1. lists the conditions); or
any of the exceptions to the fee agreement process applied at the time the decision maker made the favorable determination on the claim or PE action or, if later, disapproved the agreement (GN 03940.001C.2. lists the exceptions or exclusions).
NOTE: Generally the decision maker approves or disapproves a fee agreement when making the determination favorable to the claimant. However, sometimes the decision maker considers the fee agreement at a later time, e.g., if the fee agreement filed with SSA is not referred to the decision maker before he/she favorably decides the claim.
Reverse the previous determination and approve the fee agreement if:
the fee agreement met all of the conditions for approval; and
none of the exceptions applied at the time the decision maker made the favorable determination on the claim or PE action or, if later, disapproved the agreement.
Affirm the previous disapproval if:
the fee agreement did not meet all of the conditions for approval; or
one or more exceptions applied at the time the decision maker made the favorable determination on the claim or PE action or, if later, disapproved the agreement.
The decision maker disapproved a fee agreement because it was not signed by the representative. The representative requested review of the disapproval and submitted a signed fee agreement to correct the omission. The reviewer must affirm the disapproval because the fee agreement did not meet the signatory requirement when the decision maker favorably decided the claim.
The representative filed the fee agreement signed by him and the claimant with an SSA office on January 7. The decision maker, in another SSA office, made a favorable determination on January 13. On January 17, the claimant was declared legally incompetent by a State court. Subsequently, the decision maker received and disapproved the fee agreement. The reviewer must affirm the disapproval. The fee agreement met all of the statutory conditions for approval and none of the exceptions applied when the decision maker favorably decided the claim. However, one of the exceptions applied when the decision maker received and disapproved the agreement, i.e., the claimant had been declared legally incompetent.
2. Issue Notice of SSA's Determination
To issue a notice of SSA's determination:
Follow GN 03960.070 to prepare the letter to the requester, consistent with b. through g. below, for release over the signature of the Assistant Regional Commissioner for Management and Budget in the PSCs; the Director of the Office of Central Operations; or his/her designee. Refer to GN 03960.085 for model letters.
Include a brief explanation of your good cause finding, if the requester did not file timely and you did not resolve the issue in your acknowledgment or interim letter(s).
Respond to the issue(s) raised.
If you have affirmed the disapproval:
Explain both your action and that the representative must request approval of any fee he/she wants to charge and collect.
Enclose an SSA-1560-U4 with the letter or copy sent to the representative.
In a title II case involving an attorney representative, follow GN 03930.090 when more than 60 days have elapsed since SSA first advised the attorney of the need to request fee approval under the fee petition process. (This will advise the claimant and attorney that in order to receive direct payment from past-due benefits withheld, the attorney must file within 20 days a written request for approval of a fee or an extension of time to file the request.)
Proceed to f. below.
If you have reversed the disapproval, explain why you now approve the fee agreement.
In a title II case, depending on whether you know the past-due benefits amount, include either the amount of the fee under the agreement or a statement that SSA will authorize the fee when past-due benefits are determined.
NOTE: If you authorize the fee following GN 03940.001E., you also must include an explanation of the procedure for review of the fee resulting from the agreement.
In a title XVI case, state that SSA will authorize the fee when past-due benefits are determined.
State that you are sending copies of the determination to the party or parties named and the decision maker.
State that the determination concerning an affirmation of a disapproval is not subject to further review.
Send copies of the determination to the other party(ies) and the decision maker, as GN 03960.030B. requires.
See GN 03960.060.1. in a title II case, or GN 03960.065.1. in a title XVI case, or both, for subsequent actions which vary depending on the result.