Identification Number:
GN 03905 TN 3
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Forms, Exhibits and Notices for Representatives
Type:POMS Transmittals
Program:All Programs
Link To Reference:

Part GN – General
Chapter 039 – Representation and Representative's Fee
Subchapter 05 – Forms, Exhibits and Notices for Representatives
Transmittal No. 3, 02/03/2020


Originating Component


Effective Date

Upon Receipt


This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.


Summary of Changes

GN 03905.040 Form SSA-1128 Representative Involved

add link to Form SSA-1129.

GN 03905.040 Form SSA-1129 Representative Fee Case Past-due Benefits Summary

A. When to use

We use this form to manually calculate the past-due benefits and the resulting representative’s fee. See GN 03920.045 for more information.

B. Exhibit

See Form SSA-1129 for the most current PDF.


GN 03905 TN 3 - Forms, Exhibits and Notices for Representatives - 2/03/2020