Identification Number:
EM-19010 SEN REV
Intended Audience:All RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/OCO-CSTs
Originating Office:ORDP OISP
Title:Field Office Processing Instructions for Concurrent Cases Involving Unknown or Unresolved Representative Fees
Type:EM - Emergency Messages
Program:Title II (RSI); Title XVI (SSI); Disability
Link To Reference:See References at the end of this EM.
 
Retention Date: April 25, 2020

REVISIONS: 10/25/2019
    · Added language to explain FO technicians should no longer use the “Penny Process” when coding fee information on the SSR. However, PC technicians should still follow the instructions in step 11 on page 10 of the e4345 PC User Guide to code fee information into the e4345 application.
    · Added instructions for processing cases where we cannot determine the total amount of the Title II fees until all associated auxiliary claims have been processed or the auxiliary does not file a claim within the protected filing time limits on the Title II application as specified in his or her closeout notice.
    · Added language to clarify the requirement to complete any adjustments to the records due to a fee.
    · Added Example 4 to Section F.

A. Purpose

    This emergency message (EM) provides instructions for FO technicians responsible for coding and controlling concurrently awarded cases in which representative fees are unknown or unresolved at the time of effectuation, such as when:

      · A representative does not file a fee agreement;

      · The fee agreement is disapproved;

      · The proper party (e.g. claimant or representative) timely requests administrative review of our fee petition decision;

      · A claimant has multiple representatives and not all representatives have filed petitions for fees; or

      · The claimant is responsible for fees paid from the auxiliary beneficiary’s claim in addition to fees paid on their own claim.


    Effective immediately, Title XVI technicians must follow the instructions below to process concurrent allowances with unknown or unresolved representative fees at the time of effectuation. This is especially important with cases where the claimant is responsible for fees paid from the auxiliary beneficiary’s claim in addition to fees paid on their own claim. See GN 03920.035B.2 & GN 03940.050A.4 NOTE 2.
IMPORTANT: These instructions do not apply to cases where:

    · The fee is authorized at the time of the award, and

    · Neither the claimant nor the representative request an administrative review of the fee within 30 days after the date of the notice of initial fee authorization (GN 03950.010A), and

    · There is no auxiliary beneficiary (ies) or all auxiliary beneficiaries have appointed their own representative(s).


      NOTE: We consider the claimant’s appointed representative to act also on behalf of the auxiliary beneficiary (ies) and be entitled to a fee, unless the auxiliary beneficiary (ies) appoints his or her own representative. See GN 03910.025 for more information on this policy.

    Field office (FO) technicians should no longer code the Supplemental Security Record (SSR) with an approved fee petition of $0.01 when the fees are unknown or undecided at the time of effectuation. FO and Processing Center (PC) technicians will still work together to complete the initial offset using the e4345 application. The e4345 application currently does not have the ability to record an unresolved fee. FO technicians will continue to receive e4345s from the PCs coded as an approved fee petition for $0.01 as stated in the e4345 PC User Guide. However, the fee status on the SSR will be left as unresolved.

B. Background

    We are required to perform windfall offset calculations on concurrent awards that have an overlapping period of eligibility. Authorized fees can affect a windfall offset computation by reducing the total amount of Title II past-due benefits counted in the windfall period. When representative fees are authorized in concurrent cases with an overlapping period of eligibility, you must deduct the entire amount of the authorized fees from the Title II past-due benefits. This deduction begins with the first month the Title II past-due benefits would have been paid if paid when due. You must perform this deduction before you compute the windfall offset. See SI 00830.100 & SI 02006.200C.

    Cases in which representative fees are unknown or unresolved at the time of effectuation add additional complexity. In these cases, the fee determination is delayed and you may be required to first calculate the windfall offset before the fee is authorized and hold back past-due benefits for payment of potential fees. See SI 02006.210B.

    Once you know the total amount of fees for which the claimant is responsible, whether authorized by the agency, the court awarded fee per 406(b) of the Social Security Act (Act), or both, you must pay the Title XVI portion of the authorized representatives’ fees (if there are any) and adjust the SSR to account for the total authorized fees. When calculating the total authorized fee amount, remember to include the amount of any additional fees paid from auxiliary beneficiary’s claims when the claimant is responsible for the fee. See GN 03920.035B.2 and GN 03930.032.

    It is critical that decision-makers, adjudicators, and authorizers responsible for processing representative fee actions and windfall offsets are proactive in controlling this important workload and communicating with one another at all phases in the process.


C. FO deadline for adjusting the SSR to account for the total authorized fees when the representative fees were unknown or unresolved at the time of effectuation

    Once you know the total amount of the representative fees for which the claimant is responsible, whether authorized by the agency, the court per 406(b) of the Act, or both, you must update the Title XVI record with the authorized fee information and adjust the SSR to account for the total Title II and Title XVI authorized fees by the deadlines listed below. The total amount of the fees includes any additional fees paid from auxiliary beneficiary’s claims when the claimant is responsible for the fee. See GN 03940.050A.4 NOTE 2 & GN 03920.035B.2.

    1. Fee petition

    The FO must complete the adjustment to the SSR to account for the total amount of the fees authorized by the agency and the court per 406(b) of the Act, if applicable, within 120 days of the latest fee authorization date.

    2. Fee agreement – Number Holder (NH) and no auxiliary fees


IF ALL OF THE FOLLOWING ARE TRUE:

The NH’s representative(s) requested payment through a fee agreement,

We approve the fee agreement, and

      At the time the claim is effectuated we withhold the maximum fee amount from the NH’s past due benefits,
THEN:
      The FO must complete any necessary fee adjustments to the windfall offset data within 120 days of the latest fee authorization date.

    NOTE: DO NOT assume there are no auxiliaries on the record. If you do not know how to read the Master Beneficiary Record (MBR) or check Modernized Claims System (MCS) for auxiliary applications, check for an MDW for aux development. Also, check with your Title II counterpart in the FO or with the PC to confirm there are no auxiliaries before completing the adjustment to the SSR to account for the fees.

    3. Fee agreement – NH and auxiliary fees


IF ALL OF THE FOLLOWING ARE TRUE:

The NH’s representative(s) requested payment through a fee agreement,

We approve the fee agreement,

There is an indication of possible auxiliary fees at the time the claim is effectuated, and

      The money withheld from the NH’s past due benefits will not reach the maximum fee payable.
THEN:
      The FO must complete any necessary fee adjustments to the windfall offset data within 120 days of the latest authorization date for the total amount of Title II fees.

    Title II computes the total fees by adding the fees from the NH and any auxiliaries on the record. The NH is liable for those fees. Once the PC computes the total Title II fees, the PC will communicate this information to the FO. The FO then has 120 days to complete any necessary fee adjustments to the windfall offset data.

    If an auxiliary does not file a claim within the protected filing time limits on the Title II application as specified in his or her closeout notice, the FO must complete any necessary fee adjustments to the windfall offset data within 120 days from the closeout date for the auxiliary claim. For example, if a closeout notice states an auxiliary must file a claim by 05/01/2019 to keep the same protected filing date as the NH and the auxiliary does not file a claim by that date, the FO must complete any necessary fee adjustments to the windfall offset data within 120 days from 05/01/2019.


D. NOTE: In some cases, the decision-maker or component with jurisdiction over the fee may authorize a representative to collect a fee in one notice and set the fee amount in another notice. In this situation, adjust the SSR to account for the total amount of the authorized fees within 120 days from the date the last notice was sent.

E. FO instructions for coding unknown or unresolved fee decisions in the Title XVI claim system Modernized Supplemental Security Income Claims System (MSSICS)


    1. Identifying offset cases with unknown or unresolved representative fees
These instructions apply to cases with all the following characteristics:
      · Individuals awarded concurrent benefits with an overlapping period of eligibility,
      · At least one representative is involved, is eligible to charge a fee, and did not waive his or her fee, and
      · The total amount of the fee is unknown or unresolved at the time of effectuation, e.g.:
          o There is no fee agreement decision on record;
          o The fee agreement is disapproved;
          o A fee petition has not been submitted;
          o A fee petition has been received but not yet decided;
          o We received an intent to file a fee petition but the representative has not filed a fee petition yet;
          o Administrative review is pending for the authorized fee decision or amount;
          o Administrative post-award actions (i.e. workers compensation development) have not been completed to determine amount of past-due benefits and resulting fee amount;
          o At least one representative may be eligible for fees for services before the agency and 406(b) fees for services before a court, but at least one of these issues is not resolved; or
          o There is at least one auxiliary claim pending and the claimant is responsible for any fees resulting from an award of auxiliary benefits. See GN 03920.035B.2.
    2. Representative Fee Processing Instructions Overview

      Always assume a representative will file a fee petition if the representative:

        · Has not waived his or her fee;

        · Has not filed a fee agreement before the favorable determination or decision; or

        · Submitted a fee agreement and we disapproved it.


      If a representative submits a fee petition to the FO at any time during this process, follow the instructions in GN 03930.025 regarding receipt and routing of fee petitions.

      Effective immediately, follow the instructions in charts 1 through 5 below for all cases that meet the criteria in Section D.1 of this EM.


    3. Summary of Chart Contents

      Chart 1 – Claim Effectuation: Explains how to code the SSR when effectuating the Title XVI decision.

      Chart 2 – FO Monitoring for Fee Status: Provides instructions for monitoring the status of the fee. For some cases, you will need to return to this chart every 60 days.

      Chart 3 – Initial Windfall Offset Computation: Provides instructions to ensure the initial windfall offset computation is complete. In most cases, the system will automatically perform this computation. However, you will need to ensure an initial windfall offset computation was completed before applying the instructions in Chart 5.

      Chart 4 – Release of Withheld Past-Due Benefits: Provides instructions for releasing the past-due benefits withheld for fee purposes. These instructions will only apply to cases where the individual would not have been eligible for any past-due Title XVI benefits had Title II benefits been paid when they were due. See GN 03920.031.

      Chart 5 – Fee Authorized: Explains how to update the SSR to account for the total authorized fees when the representative fees where unknown or unresolved at the time of effectuation.

      For your convenience, we have also provided some examples in Section E of this EM.

Chart 1 – Claim Effectuation

Follow these instructions when effectuating the Title XVI decision.

Step
      Action
      1. Review the representative’s information on the UATH screen for accuracy.
      2. Annotate the UFEE screen to show “FEE SITUATION: 1=UNKNOWN OR UNRESOLVED FEE”.
      3. Ensure that Direct Payment Waived is answered “N” on the UFEE screen if the representative is eligible for direct pay.
      4. On CMEN screen, enter ‘Y’ next to ‘SSR REMARKS’. On CRMK screen, enter the following remark on the SSR:

      MM/DD/YY – UNRESOLVED FEE CASE – WAITING ON FEE AUTHORIZATION / (your 3 digit unit code & FO code)

      Effectuate the claim (i.e., calculate benefits and pay ongoing benefits.)

      5. If the case meets the requirements in SI 02101.025 for a prepayment review, have a reviewer complete the prepayment review.

      The simulated SSR should now show a UPV of V, 2, or B.

      The simulated SSR should also compute and set an amount in the Estimated Fee Withholding (EFW) field whenever the representative is eligible to receive direct payment.

      6. When there is no fee agreement, send a manual notice using the template titled “Fee Petition Notify Recipient of Past-Due Ben W/H” in DPS to the claimant.

      In the notice, inform the claimant that his or her representative must file a fee petition or a statement of intent to file a fee petition within 60 days of the date we mail the notice of the favorable determination or decision if the representative wishes to receive direct payment of a fee authorized by the agency from the claimant's withheld past-due benefits.

      Explain we are withholding some of the claimant’s past-due benefits for possible fee payment whenever the representative is eligible to receive direct payment. See GN 03930.030C.4.

      If there is no spouse on the record, remove any language from the notice regarding a spouse’s benefits.

      If we include the claimant's eligible spouse's past-due benefits in the claimant's past-due benefits for representative fee purposes, leave the language regarding spouse’s benefits in the notice and complete the appropriate fill-ins. Also, be sure to create the same notice using the same template under the spouse’s SSN for his or her records.
      7. Send a copy of the claimant's notice (and the spouse's notice if applicable) to the representative or the principal representative (as GN 03910.050B. requires). Also, send a copy to the representative payee and/or legal guardian, if applicable. See GN 03930.030C.5.

      NOTE: Although a representative who was discharged by the claimant may file a fee petition, we will not release a copy of the claimant's award notice to a discharged representative without the claimant's prior written consent.

      Federal Court Cases: We may only disclose information to attorneys at the Federal court level per GN 03910.025.

      8. Set a “FEEAUTHPEND” issue with a follow-up date for 60 days (120 days for federal court cases) on the MSSICS DW01 or MDW for non-MSSICS cases. This issue will control for the receipt of the fee authorization.

      Set a “FEE UPDATE” issue on the DW01 or MDW for non-MSSICS cases with a follow up to match the “FEEAUTHPEND” issue. This issue will control for adjustments you will need to make to the SSR after you know the total amount of the representative fees authorized. DO NOT receipt in this issue until you have successfully adjusted the SSR to account for the total representative fees authorized, including any fees resulting from an award of auxiliary benefits for which the claimant is responsible. See GN 03920.036B.2. Also, add the phrase, “SEE DROC” to the corresponding remarks lines for both issues.

      On a new Report of Contact (DROC) screen, type the phrase “FEE AUTHORIZED–ADJUST SSR” in the subject line. Then, copy and paste the following text into the REPORT TEXT:

      THIS CASE CONTAINS A PERIOD OF WINDFALL OFFSET AS WELL AS POTENTIAL FEES FOR REPRESENTATION. FOLLOW THE INSTRUCTIONS IN EM-19010 SEN REV AFTER ALL FEES FOR REPRESENTATION ARE RESOLVED.

      *** DO NOT RECEIPT IN “FEE UPDATE” ISSUE UNTIL YOU HAVE SUCCESSFULLY ADJUSTED THE SSR TO ACCOUNT FOR THE TOTAL REPRESENTATIVE FEES AUTHORIZED, INCLUDING ADDITIONAL FEES FROM AN AUXILIARY CLAIM WHEN THE CLAIMANT IS RESPONSIBLE FOR THOSE FEES. SEE GN 03920.036B.2***

      Lock the DROC.

Chart 2 – FO Monitoring for Fee Status

If you do not receive notification of an authorized fee from the Processing Center (PC), Office of Hearing Operations (OHO), or Office of Appellate Operations (OAO) before the “FEEAUTHPEND” issue matures, follow these instructions. You may need to repeat this process more than once.

Step
      Action
      1. Once the “FEEAUTHPEND” issue has matured, check the Master Beneficiary Record (MBR), Online Retrieval System (ORS), Claims File User Interface (CFUI), Case Processing and Management System (CPMS), Electronic Viewing System (eView) and Processing Center Action Control System (PCACS) to determine if a fee has been authorized. SI 02006.202B also provides additional instructions for determining if the fee has been approved.

      If you do not find anything indicating a fee has been authorized, update the MSSICS DW01 or MDW to extend the TICKLE another 60 days and repeat as necessary until you receive the fee authorization. See GN 03930.030.

      NOTE: For court cases, you may need to check PACER to determine if a court fee petition was filed.

      2. The PC will follow the instructions in GN 03930.090 if we do not receive a fee petition from the representative. However, even if the PC sends a notice informing the representative that he or she must request payment for any authorized fees directly from the claimant, FO technicians must continue to monitor the status of the fee.

      NOTE: The total authorized fee amount will be used in any adjustments to the SSR even if we do not pay the fee to the representative directly.

      3. Continue to Chart 3 – Initial Windfall Offset Computation in this EM.
Chart 3 – Initial Windfall Offset Computation

Follow these steps to ensure the initial windfall offset computation is completed.

Step
      Action
      1. Determine if the system was able to compute the initial windfall offset automatically. Completing Step 4 of Chart 1 above should have allowed the initial windfall offset computations to automate, even with the fee status as unknown or unresolved. Check the Windfall Indicator (WIN) codes on the SSR to determine if the offset was completed. See SM 01320.021.

        · If a limitation or exclusion prevents automation of the initial windfall offset, an offset diary (e.g., 5W, 7W, etc.) will post to the SSR. If an offset diary posts, follow the instructions in SM 01320.010 to take any necessary action.

        · If a 2L diary posts, follow instructions in SM 02001.217 to resolve any discrepancies between the fee statuses posted to the MBR and the SSR. However, if the only discrepancy is that the SSR correctly reflects a fee status of unknown or unresolved, delete the 2L diary, and send to the SSR.


      Once you have resolved any of the diaries preventing windfall automation, review SI 02006.210 & SM 01320.001 to locate any further instructions you may need to complete the initial windfall offset.
      2. If we are still withholding any Title XVI past-due benefits for possible fee payment, review Chart 4 in this EM to determine if you can release any remaining past-due benefits we are withholding.
Chart 4 – Release of Withheld Past-Due Benefits

In certain situations, you may be able to release the past-due benefits we are withholding for fee purposes on the T16 record. Use this chart to determine if you can release any Title XVI benefits being withheld for possible fee payment prior to the authorization of the fee.

      1. Ensure any Interim Assistance Reimbursement (IAR) payment has been issued. If there is an outstanding IAR issue, refer to SI 02003.001 to resolve.
      2. Determine if the case is subject to installments. See SI 02101.020.

      If the case is subject to installments and no further past-due benefits can be issued at this time, stop. You will not be able to apply the instructions in Chart 4 until you are releasing the final installment.

      NOTE: Ensure you follow the instructions for releasing underpayments into dedicated accounts per SI 02101.020.

      3. If the case is not subject to installments or you are releasing the final installment, determine if any of the Title XVI past-due benefits are counted for fee purposes.

      NOTE: There will be no Title XVI past due benefits for fee purposes if the individual would not have been eligible for any past-due Title XVI benefits had Title II benefits been paid when they were due. See GN 03920.031.


        · If any portion of the Title XVI past-due benefits are counted for fee purposes, you should use option 5 on the UOUP screen to release all of the remaining underpayment. The system should release the remaining underpayment except the 25% withheld for fees in the EWF field, and will set the UPV to A.

        · If there are no Title XVI past-due benefits for fee purposes, you should use option 5 on the UOUP screen. The system will release the remaining underpayment except for the 25% that is posted in the EFW field. This will set the UPV to A. In addition, you should issue an automated one-time payment (A-OTP) to the individual for the remaining 25% that was withheld for fees. See SM 01901.005.

      4. Even if you are able to release all of the Title XVI past-due benefits withheld for fee purposes, you must continue to monitor the status of the fee. An authorized fee may affect the windfall offset computation even if SSA does not directly pay the fee. See SI 02006.200. Continue to monitor the case following the instructions in Chart 2 of this EM until you know the total amount of fees authorized.
Chart 5 – Fee Authorized

Once you receive notification from the PC, OHO, or OAO of the authorized fee, see section C of this EM to determine when you must complete the adjustment to the SSR to account for the fees.

Federal Court Cases: Check PACER for a fee request for cases at federal court.

Step
      Action
      1. Locate the “FEEAUTHPEND” issue on the DW01 or MDW. Type the date the PC, OHO, or OAO notified your office of the fee approval in the RECEIVED column.
      2. If you are able to adjust the record for the authorized fee right away, go to step 3 below.

      If you are not going to process the adjustment right away, for example if you are still waiting for a fee decision for an auxiliary claim, set a TICKLE for the “FEE UPDATE” issue 60 days in the future. You will need to continue to follow up with this case every 60 days until all fees for all associated claims have been finalized. When all fees for all associated claims have been finalized, receipt in the “FEE UPDATE” issue and go to step 3 below.

      NOTE: You must proceed to step 3 in this chart before the deadline established by section C of this EM for your case.

      3. Update the UFEE screens to reflect the authorized fee and send the updated information to the SSR. Ensure the Type U income posted to the SSR correctly. If the Type U income is posted correctly, move on to step 5 in this chart.

      If the initial windfall offset is complete but the Type U income did not post properly, you will need to adjust the Type W income on the UW02 screen to account for the missing or incorrect Type U income. Use the SSA-2894 worksheet to help you calculate the adjustment to the existing windfall data. Record the changes you made to the UW02 screen on a DROC and explain why the changes were necessary including your math for determining an adjustment was necessary. Upload the SSA-2894 into the claimant’s electronic folder using NDRED. Transmit the update to the SSR and confirm the system is properly adjusting the Type W income. The system will calculate any overpayment or underpayment due. Send the appropriate notice as explained in SI 02006.010E.6. Then, return to this EM and complete steps 5 & 6 below in this chart.

      4. Remove the remark you added to the SSR in step 4 of the Claim Effectuation chart (Chart 1) in this EM using the CRMK screen.
      5. Locate the “FEE UPDATE” issue on the DW01 or MDW. Type the date you complete the adjustment to the SSR in the RECEIVED column.

      If there is an e4345 for the case you are working on, follow the e4345 FO User Guide to complete the e4345.

      6. Follow the procedures in SM 01320.000 to address any diaries.
F. Examples

    Example 1This example illustrates a scenario where the fee is unknown or unresolved when the Title XVI decision is effectuated.

    Tom was awarded concurrent benefits. Tom had an appointed representative who was eligible to charge a fee. Tom’s representative did not submit a fee agreement before Tom’s case was awarded.

    Denise, a claims specialist (CS) in Tom’s local FO, processed his case, following the instructions in this EM and coded the UFEE screen to show “FEE SITUATION: 1=UNKNOWN OR UNRESOLVED FEE” and established the “FEEAUTHPEND” issue on the DW01 when she processed Tom’s award.

    32 days later, Denise received notification via email from the PC that Tom’s representative was authorized to charge and collect a fee. Denise followed the instructions on Chart 5 in this EM to update Tom’s record. She noted the initial windfall offset had automated with no exceptions. She updated the UFEE screens and sent the update to the SSR. The simulated SSR showed:


      · UMIH with Type U income; and

      · PMTH showing the system released an underpayment that takes into account RMA and corresponding months of Type U income.


    Once she confirmed the system accounted for the fees and computed the underpayment, she typed the date of completion in the RECEIVED column for the “FEE UPDATE” issue.

    Example 2This example illustrates the steps needed when a fee is unknown or unresolved when the Title XVI decision is effectuated and fee authorization is delayed for an extended period.

    Zoey was awarded concurrent benefits. Zoey had an appointed representative who was eligible to charge a fee. Zoey’s representative submitted a fee agreement, but the administrative law judge (ALJ) did not authorize the fee because the agreement did not meet the statutory requirements for approval (GN 03940.003).

    Robert, a CS in Zoey’s local FO, processed her case, following the instructions in this EM and coded the UFEE screen to show “FEE SITUATION: 1=UNKNOWN OR UNRESOLVED FEE” and established the “FEEAUTHPEND” issue on the DW01.

    The PC had not notified Robert’s FO of any authorized fee for Zoey’s claim. 61 days later, Robert checked his TICKLEs in WAC and noticed the “FEEAUTHPEND” issue on Zoey’s case had matured. He followed the instructions in CHART 2 in this EM and checked the MBR, ORS, CFUI, eView, PCACS, and PACER to determine if a fee had been authorized. He did not find any indication that a fee was authorized. Robert adjusted the TICKLE to follow up once again in 60 days.

    While Robert was reviewing the case, he double-checked to ensure both the initial windfall offset and IAR payments were resolved following the instructions in Charts 3 and 4 in this EM. As expected, the system had automated both actions and Robert did not need to take any further action on either of those two issues.

    Robert then moved on to Chart 4. Because Zoey’s case was still subject to installments and the system was properly controlling and releasing her past-due benefits, Robert did not need to take any action to address Zoey’s past-due benefits at this time.

    Robert checked Zoey’s record every 60 days. 181 days later, Robert followed the instructions on Chart 2 of this EM and discovered a fax in the CFUI from the PC that had been uploaded into Zoey’s electronic folder. The fax authorized Zoey’s representative to charge and collect a fee. Robert followed the steps on Chart 5 to update the UFEE screen on Zoey’s record and sent the update to the SSR. The simulated SSR showed:


      · UMIH with Type U income; and

      · PMTH showing the system released an underpayment that takes into account RMA and corresponding months of Type U income.


    He then receipted in the date of completion in the RECEIVED column for the “FEE UPDATE” issue.

    Example 3This example illustrates one scenario when we can release the past-due Title XVI benefits that we are withholding for possible fee payment.

    Bonnie was awarded concurrent benefits. Bonnie had an appointed representative who was eligible to charge a fee. Bonnie’s representative did not submit a fee agreement before her case was awarded.

    Robin, a CS in Bonnie’s local FO, processed her case, following the instructions in this EM and coded the UFEE screen to show “FEE SITUATION: 1=UNKNOWN OR UNRESOLVED FEE” when she processed Bonnie’s award.

    61 days later, Robin noticed the “FEEAUTHPEND” issue on Bonnie’s case had matured. She followed the instructions in CHART 2 in this EM. The PC had not notified Robin’s FO of any authorized fee for Bonnie’s claim. Robin checked the MBR, ORS, CFUI, eView and PCACS to determine if a fee had been authorized. She did not find any indication that a fee was authorized. Robin adjusted the TICKLE to follow up once again in 60 days.

    After Robin adjusted the TICKLE, she worked her way through Chart 3, noting that the initial windfall computation had automated and continued through Chart 4. As she worked her way through Chart 4, Robin realized Bonnie’s case was a “full offset.” Bonnie would never have been eligible for any Title XVI benefits if her Title II benefits had been paid on time. Additionally, Bonnie’s recurring monthly Title II benefit amount was so high that Bonnie was no longer eligible for monthly Title XVI payments.

    Robin determined there was no need to withhold any of Bonnie’s past-due Title XVI benefits for possible fee payment any longer because:

    1. Bonnie was no longer subject to installments, and
    2. None of Bonnie’s Title XVI past-due benefits were subject to fees for representation.

    Robin released all of Bonnie’s remaining past-due Title XVI benefits following the instructions provided in Chart 4.

    15 days later, Robin received notification from the PC that Bonnie’s representative was authorized to collect a fee. Robin followed the instructions on Chart 5 in this EM to update Bonnie’s record. She updated the UFEE screens and sent the update to the SSR. The simulated SSR showed:


      · UMIH with Type U income; and

      · PMTH showing the system released an underpayment that takes into account RMA and corresponding months of Type U income.


    Once she confirmed the system accounted for the fees and computed the underpayment, she typed the date of completion in the RECEIVED column for the “FEE UPDATE” issue.

    Example 4This example illustrates the steps needed when a fee is unknown or unresolved when the Title XVI decision is effectuated and the total amount of the fee is delayed for an extended period because of additional fees due from an auxiliary claim.

    Jeff was awarded concurrent benefits. Jeff had an appointed representative who was eligible to charge a fee. Jeff’s representative submitted a fee agreement. The fee agreement was approved by the ALJ. Jasmine, a CS in Jeff’s local FO, processed his case. Jasmine noticed Jeff had a two auxiliaries listed on his record, a spouse and a child. Jasmine realized that because the two auxiliary claims had not been processed yet, she did not know the total amount of the authorized fees.

    Jasmine follow the instructions in this EM from Charts 1 through 5, stopping at step 2 on Chart 5. She coded the UFEE screen to show “FEE SITUATION: 1=UNKNOWN OR UNRESOLVED FEE” and established the “FEEAUTHPEND” issue and a “FEE UPDATE” issue on the DW01. She receipted in the “FEEAUTHPEND” since the fee agreement was approved by the ALJ. She set a TICKLE for 60 days for the “FEE UPDATE” issue. Jasmine completed her PERC with Jeff, closed the event and updated the SSR. The system successfully computed the initial windfall offset.

    61 days later, Jasmine was checking her TICKLE list in WAC and noticed the “FEE UPDATE” issue on Jeff’s case had matured. She followed the instructions in step 2 of chart 5 in this EM. One of the auxiliary claims on Jeff’s record had been processed, but the other had not. Jasmine extended the TICKLE for the “FEE UPDATE” issue another 60 days.

    20 days later, Jasmine received notification from the PC of the authorized fees for the Title II claims. The PC had processed both auxiliary claims to completion and determined the fee amounts for both claims. Jasmine now knew the total authorized fee amounts. Jasmine followed steps 2 through 6 on Chart 5 to update the UFEE screen on Jeff’s record and sent the update to the SSR. The simulated SSR showed:


      · UMIH with Type U income; and

      · PMTH showing the system released an underpayment that takes into account RMA and corresponding months of Type U income.


    Once she confirmed the system accounted for the fees and computed the underpayment, she typed the date of completion in the RECEIVED column for the “FEE UPDATE” issue.


    G. Helpful Links

    e4345 2.0
    SSI eComputations

    H. Closing


      Direct all program-related and technical questions to your Regional Office (RO) support staff or Program Service Center (PSC) Operations Analysis (OA) staff. RO support staff or PSC OA staff may refer questions, concerns, or problems to their Central Office contacts.

    I. References

    GN 03910.050 – Contacting a Represented Claimant
    GN 03920.031 – Representative’s Fee – Title XVI Past-Due Benefits
    GN 03920.035 – Title II Past-Due Benefits Subject to Withholding
    GN 03930.025 – Receipt and Routing of Fee Petitions
    GN 03930.030 – Title XVI - Adjudicating Claims and Posteligibility Actions Involving Representatives Who May Petition
    GN 03930.032 – Direct Payment to the Appointed Representative Under the Fee Petition process for Title XVI and Certain Title II Concurrent Cases and Windfall Offset Calculation
    GN 03930.090 – No Fee Petition or Fee Authorization Received By PC or FO Before Diary Matures and SSA is Withholding Past-Due Benefits – Non-Court Case
    GN 03940.050 – Title XVI – Field Office Processing of Fee Agreements on Favorably Decided Concurrent Title II and Title XVI Claims
    MS 00302.014 – Representative Fee Update Data (UFEE)
    MS 00304.018 – Underpayment Processing (UOUP)
    MS 04423.002 – Clearance Menu (CMEN)
    MS 04423.003 – SSR Remarks (CRMK)
    SI 02006.200 – Title II and Title XVI Offset Cases – Subtraction of Authorized Fees from Title II Retroactive Payments
    SI 02006.210 – Field Office Representative Fee Adjustment Procedures Summary and Worksheets
    SI 02101.010 – Past-Due Benefits Payable - Individual Alive Under Age 18 with Representative Payee - Dedicated Account Required
    SI 02101.020 – Large Past-Due Supplemental Security Income (SSI) Payments by Installments – Individual Alive
    SI 02101.025 – Basic Requirements of Supplemental Security Income (SSI) Underpayment (UP) Review
    SM 01311.662 – Processing Interim Assistance Reimbursement (IAR) from an SSI Underpayment
    SM 01320.001 – Finding Windfall Offset Related Instructions
    SM 01320.010 – Windfall Offset Diaries and Alerts - W1, 3W, 4W, 5W, 6W, 7W, 8W, 9W
    SM 01320.021 – Windfall Indicator (WIN) Codes Used in the Automated Offset Process
    SM 01320.400 – Recomputation of Title II Offset
    SM 01901.005 – When to Use One Time Payments (OTPs)


    EM-19010 SEN REV - Field Office Processing Instructions for Concurrent Cases Involving Unknown or Unresolved Representative Fees - 10/25/2019