Fee and possible fee violations are those related to charging and collecting a fee. A fee violation usually occurs when a representative collects a fee that we did not authorize or collects a fee in excess of the amount we authorized. However, there are other examples of a fee or possible fee violation in GN 03970.010.
When a question of a possible violation arises, use common sense and good judgment. In some situations, a suspected violation might be a simple misunderstanding that our technician can resolve with a contact. For example, a non-attorney selects the wrong block on the SSA-1696 (Claimant's Appointment of a Representative) and mistakenly presents himself as an attorney. After a brief phone call, the representative sends an amended SSA-1696 to correct the error, and our technician determines that the error was unintentional.
At other times, a contact may even rectify the violation. For example, a representative received $1000 in excess of the fee we authorized. Upon notification by our technician, the representative agrees to return the excess fee. In this case, and other suspected fee violation cases (For example, direct payment errors, unauthorized fees, fees in excess of the authorized amount), allow the representative reasonable time (or an amount of time agreed to) to correct the problem. If at the end of that period, the representative has not taken any action to correct the problem, develop and refer fee and possible fee violations following the instructions outlined in this subsection. In those cases where limited information is available, collect as much information as possible. For sample notice language for duplicate or excess payments, refer to GN 03970.025C.
NOTE: If the suspected violation is criminal or involves fraud do not contact the representative. For a possible non-fee violation (For example, representative failed to provide competent representation), refer to GN 03970.010D.1. or GN 03970.010E.1, regarding whether to contact the representative.
However, you may contact a representative if the alleged violation relates to the requirement for electronic filing or submission of evidence. You may do so prior to referring the case to OGC to inform the representative of our rules and to ascertain whether the alleged violation was a deliberate act or an oversight. When you believe that a representative has violated the duty to assist the claimant to provide required evidence, you can refer the matter to OGC pursuant to GN 03970.010D or GN 03970.010E.
Do not try to determine whether a representative’s conduct fits the exceptions in GN 03970.010B.2. IMPORTANT: Keep the information in a separate file. Never store referral development in the claims file.
a. Request the claims file and proof of payment (check or direct deposit)
If there is a paper folder and it is not in the FO, request the claim file. If the file is a certified electronic file (CEF), reference the eView or Claims Folder Records Management System (CFRMS), or, in the office to which you are referring, the case has no eView access, create a compact disc (CD) copy of the file according to the instructions in DI 81001.035.
b. Request proof of payment
In cases where the payment of the fee is material and we have paid the representative directly, you may view the Treasury Check Information System (“TCIS”), but do not use it to obtain proof of payment. OGC will obtain proof of payment directly from the Department of Treasury.
In cases where the claimant or beneficiary has paid the representative directly, ask the claimant or beneficiary to provide you with proof of payment of the unauthorized fee (For example, cancelled checks, credit card receipt, billing statement from the representative, money order receipt, or a letter or note from the representative mentioning the payment).
c. Complete form SSA-5002 (Report of Contact (RC))
Complete a report using an SSA-5002. Include a detailed description (Such as, answer questions such as who, what, when, where, and how) of the violation. Use the following instructions to complete the report.
Identify who (claimant, representative payee if applicable, representative, and witnesses) is involved in or is a witness to the event that led to the violation.
Explain the events (actions on the part of the representative and the claimant) that led to the violation. For the different violation types, refer to the examples in GN 03970.010. The following bulleted list are examples of the type of information needed in the explanation:.
Actions on the part of the representative include actions such as requesting and receiving unauthorized fees;
Actions on the part of the claimant include receiving the request for payment, paying the fee, and receiving a receipt as proof of payment of the unauthorized fees;
List what led the claimant to question the fees that his or her representative charged (For example, the fee notice or another person’s input);
Identify whether the fee was in addition to any fee(s) that we already authorized or if fee collection was completely unauthorized;
If we authorized the fee, indicate whether we authorized it through a fee petition or a fee agreement;
Determine and document whether the representative collected any money to recover costs or expenses; and
Determine and document whether the representative had a trust or escrow, agreement with the claimant, or deposited any of the fee into a trust or escrow account. For more information on escrow accounts, refer to GN 03920.025.
Identify, as described in the following list, when the events took place:
List the date the claimant received the billing statement or request for payment of the unauthorized fee(s);
If the fee was paid, determine the date the claimant or SSA paid the unauthorized fee to the representative; and
Indicate when the claimant realized that the appointed representative charged him or her an unauthorized fee.
Identify where the events took place (For example, the claimant’s home; the representative’s office; a bank or check cashing facility; through the mail).
Explain, as described in the following list, how the events took place:
How much did the representative charge;
How did the representative request the unauthorized fee (For example, orally or a billing statement);
How much did the claimant pay;
If paid, how did the claimant pay (For example, cash; check; money order; credit card; or provided a personal service for the representative);
Who did the claimant pay; and
How did the representative acknowledge payment (For example, issuing a receipt, sending a letter or note mentioning the fee payment, or orally. If orally, is there a voicemail message on the claimant’s or beneficiary’s phone.)
Identify Claimant, beneficiary, and representative
List the names, addresses, and telephones number of the representative, claimant, or beneficiary.
List the name, address, and telephone number of any witness, indicating his or her relationship to the claimant, beneficiary, or the representative.
Identify FO point of contact
List the FO’s point of contact, including the contact’s name, title, and telephone number (with the extension, if applicable).
d. Obtain copies of all documents
Obtain copies of any documents and any other evidence not already mentioned that support the “who, what, when, where, and how” that you provided. For example, claimants or beneficiaries often have letters or notes from the representative or voicemail recordings, so provide a copy of the written communication or make a note of the oral communication on an SSA-5002.
e. Obtain signed statements, if available
Obtain signed statements from any individual with direct knowledge of the facts involved, including the claimant, beneficiary, payer, and any other witnesses. Do not contact the representative for a statement. The statements should provide all details related to the events leading to the fee violation. If an individual will not cooperate or sign a statement, record this information on an SSA-5002.
f. Documenting the claimant-representative relationship
If available, include in the file a copy of the notice of appointment (For example, an SSA-1696 or another signed written equivalent); written and signed documentation of a fee arrangement between the parties; or documentation that we recognized the individual as the claimant’s representative such as a copy of the SSA-L1697 (Notice to Representative of Claimant Before the Social Security Administration).