Date:
Dear _____________:
You were authorized a fee for your representational services to [claimant's name]
in the amount of $8,000. Through error, we made a duplicate payment to you, and you
received $8,000 [subtract any user fee if applicable] in excess of the fee authorized
to you.
As a result, you owe the Social Security Administration $8,000 [subtract any user
fee if applicable]. Please refund this amount within 30 days from the date of this
notice. Make your refund payable to the “Social Security Administration” and include
the claimant’s full name and full Social Security Number (SSN) on your refund. Mail
the refund to: [Insert the FO’s or PC’s address].
If you fail to comply in a timely manner, we may refer the matter to the Office of
the General Counsel as a potential violation of our fee collection rules at [20 CFR
404.1740(c) and/or 20 CFR 416.1540(c)], which may result in proceedings to suspend
or disqualify you from practicing before SSA under 20 CFR 404.1745 and 20 CFR 416.1545.
Social Security Administration
Enclosures:
Copies of the United States Treasury checks issued to the Representative
Self-addressed, Unfranked return envelope