We are writing to tell you that the U.S. District Court for (1) approved a fee of $ (2) to pay your lawyer for the work on your claim while the court was reviewing it.

What We Will Pay Your Lawyer

Insert one of the following optional paragraphs:

3819 A  (approved fee exactly equals withheld benefits):

We withheld the $ (1) from your benefits to pay your legal expenses. Since the court has approved the fee, we are sending your lawyer this money. This means we have paid your lawyer in full for the work on your claim while the court was reviewing it.

We are sending a copy of this letter to your lawyer.

3819 B  (approved fee less than withheld benefits):

We withheld $1 from your benefits to pay your legal expenses. We will send $ (2) of this money to your lawyer. We are withholding the balance of $ (3) in case your lawyer asks us to approve a fee for work that was done before you decided to take your case to court.

We are sending a copy of this letter to your lawyer.

3819 C  (concurrent title II/XVI case subject to windfall offset)

Your SSI Payments May Change

Because we approved a fee in your Social Security claim, the amount of benefits we used in figuring your SSI payments may change. Contact your local Social Security Office to see if we can pay you more SSI money.

If You Have Any Questions

3901C - Domestic

3901D - Foreign

• •

  In this situation, the beneficiary has won an appeal in a civil suit. The program service center was holding back retroactive benefits pending a determination on an attorney fee presented to a court.

• •

  All copies should be date stamped. If the letter will not be mailed on the same day, it should be postdated. Sign all copies except the folder file copy. The copies are then released as follows:

  1. 1. 

     original to wage earner in envelope provided

  2. 2. 

     attorney's copy in envelope provided

  3. 3. 

     DO's copy to office shown on the letter

  4. 4. 

     the remaining carbons are released through the benefit authorizer's basket under cover of an OF-41 as follows:

     1. a. 

        OGC - Office of the General Counsel

     2. b. 

        remaining carbons should be forwarded to the attention of a court case examiner

  The notice contains two optional paragraphs to explain the two possible dispositions of the retroactive benefits. Optional paragraph 3819A specifies that this notice only addresses a fee charged for work done before the court. This is because an attorney may file separately with SSA to ask approval of additional fee amounts unrelated to the work done before the court.

  Optional paragraph 3819B tells the beneficiary that money left over after payment of the fee for work done before the court will still be withheld in case the attorney files for an additional fee.

  The notice will also include 3819C if this is a concurrent title II/XVI case subject to windfall offset.

• •

  Refer to NL 00703.005E for 3901C and 3901D text and fill-ins.

   

Fill-ins:

1. (1) 

   Judicial Region

2. (2) 

   amount of approved fee

3819A

1. (1) 

   amount of approved fee

3819B

1. (1) 

   amount withheld

2. (2) 

   amount of approved fee

3. (3) 

   amount of difference between approved fee and benefits withheld

Use Form SSA-L2000-C2 (Universal Notice) and follow notice standards. Information for this notice will be shown on Form SSA-573.