If a represented claimant contacts SSA or the DDS, SSA or the DDS may discuss his or her specific issue. A represented claimant does not need permission from the appointed representative to contact SSA or the DDS directly.

If the claimant appoints a representative, generally the DDS initiates all contacts connected to that claim through, or with the permission of, the appointed representative. For information about when to contact represented claimants directly, see GN 03910.050.

When the claimant has appointed multiple representatives and it is not clear who is currently appointed or who is the principal representative, DDS may contact the represented claimant directly to clarify the situation. For more information about multiple representative situations, see GN 03910.040C.

EXAMPLE: The claimant appointed two representatives at different times and the representatives do not appear to be working together. In this instance, SSA will contact the claimant directly to clarify the situation.

If the representative requests that we communicate directly with the claimant regarding a specific issue:

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  Prepare an SSA-5002 (Report of Contact), Electronic Claims Analysis Tool (eCAT) Claims Communication, or Disability Case Processing System (DCPS) Case Note to document that the DDS will deal directly with the claimant on the specific issue;

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  Include the SSA-5002, eCAT Claims Communication, or DCPS Case Note in the file. For paper cases, send a copy to the FO;

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  Post a message in eView to notify the FO of the representative's request.

If a represented claimant requests that we communicate directly with him or her regarding a particular issue:

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  Prepare an SSA-5002 describing the claimants desire to communicate directly with the DDS on that specific issue;

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  Include the SSA-5002 in the electronic folder. For paper cases, send a copy to the FO;

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  Post a message in eView to notify the FO of the claimant's request.

IMPORTANT: A represented claimant's request that the agency communicate directly with him or her on a specific issue is not a revocation of the representative's appointment. Remind the claimant that the representative continues to have access to the file, which may include information regarding the issue he or she identified.

If the representative contacts the DDS, subsequent actions taken depend on whether the DDS has issued the Personalized Disability Explanation (PDE). To determine the PDE's date of issue, see DI 81020.130D.

Take the following actions to document the claims folder:

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  Retain copies of all correspondence between the representative, SSA, and the DDS in the claims folder;

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  Document correspondence with the representative in the claims folder. Place the documentation in the DCPS Case Notes section of the Disability Determination Explanation (DDE), or on an SSA-5002. This documentation is important to evaluate the fee.

If the DDS receives representative information or fee related documents by mail or fax, the DDS returns the document to the sender following instructions in DI 31001.001B.1.

A claimant must inform us about or submit all evidence known to him or her that relates to whether or not he or she is blind or disabled. An appointed representative must act with reasonable diligence and promptness to help obtain all information or evidence that the claimant must submit and promptly forward the information or evidence to us for consideration. Appointed representatives must submit or inform SSA of all known evidence regardless of the perceived effect the evidence has on the outcome of the disability determination (i.e. whether the evidence helps or hurts the case). For examples of violations of this requirement, see GN 03970.010.

The DDS is responsible for appropriate, necessary, and correct development of all known evidence that relates to whether the claimant is blind or disabled.

Treat evidence provided by a representative as if the claimant provided it. Consider this evidence as part of the total record on which you base the determination.

Send all notices and correspondence to both the claimant and the appointed representative, as follows:

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  Send requests for developmental evidence or action (e.g., work history or disability reports, questionnaires, medical deferment, call-in letters) to the claimant and a copy to the representative.

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  Send requests to attend a consultative examination (CE) or a disability hearing to the claimant and a copy to the representative.

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  Send determination notices to the claimant and a copy to the representative.

NOTE: Sending requests to attend a CE or other requests for evidence or action to both the claimant and the representative ensures that both parties are made aware of the requests.

For notices and correspondence specific to the FO, see GN 03910.050B. For notices and correspondence specific to the Office of Hearing Operations (OHO), see HALLEX I-1-1-20.E.

If a representative is uncooperative, such as encouraging the claimant to not cooperate with SSA or DDS request for evidence, proceed with adjudication of the claim, and making direct contact with any source the representative submitted evidence from.

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  Use normal follow-up procedures and diaries described throughout DI 22505.000.

  Do not delay the case beyond the time ordinarily allowed a claimant acting on his or her own behalf. Instead, adjudicate the case on the evidence in the record.

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  Use normal failure to cooperate procedures found if either the claimant or the representative is uncooperative (see DI 23007.000).

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  Refer representatives who routinely fail to cooperate to the Disability Program Administrator (DPA). Proceedings may begin to suspend or disqualify a representative from acting as a representative if the representative violated his or her affirmative duties or engaged in prohibited conduct.

If the claim has insufficient evidence to make a disability determination, deny the claim. For information on collecting and evaluating evidence, see DI 11010.530.

Prepare form SSA-166 (Report of Representative Misconduct) to refer suspected appointed representative misconduct to OGC for possible investigation and sanctions.

Do not store any referral development in the claim folder.

Do not include a copy of the completed Form SSA-166 in the claim folder.

Email the completed Report of Representative Misconduct form to the DPA via ^DA DDS National.

Continue to adjudicate the claim after you send the referral to the DPA.

Open the Alerts/Messages section in an affected claimant's electronic case file and create a new message entitled, OGC Referral - Representative Misconduct. Do not enter an expiration date, which helps avoid premature and automatic deletion of the alert or message. If the potential violation involves evidence in the case file (or a lack of evidence), provide relevant details in the message. This information should not be accessible to non-SSA or DDS employees. If you take further action, or the DPA or OGC declines to pursue potential sanctions, document the message.

DPAs review the DDS referrals about appointed representative misconduct and determine whether to forward those referrals to OGC for further consideration.

The DPA forwards a referral to ^LP Representative Conduct and sends a copy of the referral to SSA headquarters (HQ) at ^Representative Referrals.

The DPA maintains records of:

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  Referrals they receive; and

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  Referrals they forward to OGC (and, if sent separately, of the copies sent to HQ).

OGC reviews the referral about appointed representative misconduct and takes appropriate action. Such action may include closing the case with a finding of no misconduct, informal resolution or initiating proceedings to suspend or disqualify the individual from acting as an appointed representative.

OGC may contact the referring office or region for more information or assistance.

OGC maintains records of:

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  Referrals they receive; and

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  Statuses of all representative referrals received.

Some non-fee violations may also qualify as criminal violations. If so, complete separate referrals.

If the evidence suggests both appointed representative misconduct and possible fraud or similar fault, complete a form SSA-166 (Report of Representative Misconduct), and submit a referral through the Allegation Referral Intake System (ARIS) for possible fraud or similar fault.

For more information about referrals for possible fraud or similar fault, see GN 03970.016 and DI 23025.000.

DDS management may contact your DPA to track the status of a referral.

DPAs contact OGC for status updates on a case-by-case basis or in accordance with their office policies.

OGC informs the referring component when they resolve a case.

Check the DDS box to indicate that the referral for representative misconduct originated in a DDS.

Provide the DDS location or site code and address. To obtain a code or address, go to the DDS Community>>Disability Contacts page, and select the DDS Telephone Directory.

Provide the name, title, work phone number, and work email address for the technician making the referral and for an alternate contact, likely a supervisor or other DDS designated contact.

Provide identifying information for the appointed representative. Include the appointed representative's name, applicable firm or company, telephone number, address, and the representative identification (Rep ID), if the representative is registered, or Social Security number, where applicable and available.

If the referral stems from a specific claim for benefits, provide the name and Social Security number of the claimant or Number Holder.

List the date of the incidents. For example, list the dates of conversations and written communications where an appointed representative informed the DDS that the representative and representative's client would not provide necessary information to the DDS for adjudication of a disability claim.