An affected auxiliary beneficiary is an individual who has benefited from the representative’s services to the claimant who appointed the representative. References to the “affected auxiliary beneficiary” as a party include any person authorized to act on the beneficiary’s behalf, e.g., a parent or legal guardian.

A claimant is any individual whose asserted rights under Titles II, XVI, or XVIII of the Social Security Act (Act) are, or may be, affected by our determination or decision. As used throughout this subchapter, the term includes a beneficiary. References to the “claimant” as a party include any person authorized to act on the claimant’s behalf, e.g., a parent or legal guardian.

The decision maker is the person who has responsibility for adjudicating the claim, post-entitlement, or post-eligibility action, including a fee authorization, at a given level of the administrative review process, e.g., claims specialist (CS), claims technical expert (CTE), attorney advisor, administrative law judge (ALJ), or administrative appeals judge (AAJ).

Disapproval of the fee agreement means that the decision maker determined that the fee agreement does not meet statutory conditions for approval, or one of the exceptions to the fee agreement process applies (see GN 03940.003).

Entity means any business, firm, or other association, including but not limited to partnerships, corporations, for-profit organizations, and not-for-profit organizations (see 20 CFR 404.1703 and 416.1503). A representative can assign direct payment of an authorized fee to an eligible entity per GN 03920.021.

A fee agreement is a written statement signed by the claimant and their representative(s) specifying the fee the representative(s) expects to charge and collect, and the claimant expects to pay, for services the representative(s) provides in pursuing the claimant's benefit rights in proceedings before us. A fee agreement submitted to us before the date of our first favorable determination or decision must be considered for approval under the fee agreement process regardless of when in the administrative review process the claim or other matter is favorably decided.

The notice of approval or disapproval of the fee agreement, or “fee agreement notice,” is the notice we send to the claimant and the representative explaining what action the decision maker took on the fee agreement between the claimant and the representative. The exact notice we send depends on the level at which we favorably decide the matter, as follows:

Notice of the fee determination, or fee authorization notice, is the notice that we send to the claimant and the representative(s) specifying the fee we authorize. There are two types of fee authorization notices for fee agreements:

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  In Title II and concurrent Titles II and XVI cases, the award or post-entitlement notice states the amount of the fee that we authorize the representative to charge and collect under the fee agreement process.

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  In Title XVI only cases, the Fee Agreement Notice on Form SSA-L8165-U2 (SSI Important Information), states the amount of the fee that we authorize the representative to charge and collect under the fee agreement process.

A non-requester is a person who is a party to the determination, but who did not request administrative review of the approval or disapproval of the fee agreement or of the amount of the fee authorized under the fee agreement process.

The proper party to request administrative review under the fee agreement process may be any of the parties to the agreement (see GN 03940.003B.2.), any affected auxiliary beneficiary or eligible spouse, and the initial decision maker. A proper party may be either a requester or non-requester, depending on whether they file a request for administrative review. In most cases, an entity and its point of contact (POC) are not proper parties under the fee agreement process, as they are not parties to the agreement. However, if a representative who has validly assigned direct payment of any authorized fee dies, and at least one other representative remains active on the claim (see GN 03940.003D.6.), or the representative died after the agreement was approved and an initial fee was authorized, the entity’s POC may request administrative review under the fee agreement process on behalf of the deceased representative. If the representative did not assign direct payment of their fee before dying, the executor or other legal representative of the deceased representative's estate may request administrative review.

For this subchapter on fee agreement administrative review, a representative is an individual who meets the qualifications shown in GN 03910.020A.1. or 2, and whom the claimant appoints on a Form SSA-1696 to represent them in dealings with the agency. This individual may be an attorney or non-attorney as described in those subsections.

A requester is the person who requested administrative review of the approval or disapproval of the fee agreement or of the amount of the fee authorized under the fee agreement process.

A reviewer is the agency official who has been delegated the authority to conduct administrative review, as indicated in GN 03960.005. “PC reviewer” refers to a reviewing official below the hearing level.

Our determination on administrative review under the fee agreement or fee petition process is final and binding.

Unlike administrative review under the fee petition process, which involves only a review of the amount of the fee authorized (see GN 03950.000), administrative review under the fee agreement process in §206(a)(2) and (3) of the Social Security Act (the Act), as amended, may involve two distinct issues: the review of a determination approving or disapproving the fee agreement; and the review of the amount of the fee authorized under the fee agreement.

Therefore, in some instances, a party could file two requests for administrative review:

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  The first when they received notice of the decision maker's determination on the fee agreement. The party may object to either the approval or disapproval of the fee agreement; and

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  The second when we approved the fee agreement, either initially or after reversing a disapproval on administrative review, and authorized the amount of the fee under the agreement. The party may also object to the fee amount authorized.

Administrative review under the fee agreement process also differs from administrative review under the fee petition process as follows:

1. a. 

   The party requesting administrative review must do so within 15 days of receiving the notice of determination on the fee agreement or the notice authorizing the amount of the fee. Under the fee petition process, the party requesting administrative review must do so within 30 days after the date of the notice of the fee authorization.

2. b. 

   The decision maker may:

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     Request administrative review of the amount of the fee authorized under the agreement;

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     Comment on another party's request for administrative review; and

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     Conduct an administrative review requested by the claimant, an affected auxiliary beneficiary, or the representative, if we favorably decided the claim at the hearing or AC level and the issue for review is the amount of the fee under the agreement.

     EXAMPLE: The ALJ who made the favorable hearing decision may conduct administrative review of the fee amount authorized under the fee agreement based on a request filed by the claimant.

Whether the issue is the approval or disapproval of the fee agreement or the amount of the fee, administrative review under the fee agreement process generally involves the same procedural steps that GN 03950.001C. describes for administrative review under the fee petition process. These steps are:

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  Examining the request and the file to establish authority to conduct review and timely filing by a proper party. For information about proper parties, see GN 03960.001D.10 (in this section) and GN 03960.010;

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  Notifying the processing center (PC) of the request in cases under Title II involving a representative eligible for direct payment, including cases where the representative assigned direct payment of their fee to an eligible entity;

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  Informing the parties and providing them an opportunity to comment;

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  Reviewing the initial determination; and

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  Notifying the requester and the parties of the determination on administrative review.

As under the fee petition administrative review process, these steps generally follow in sequence. However, sometimes we may not be able to act on the administrative review request, e.g., when an improper party requested review. Sometimes the steps can overlap, e.g., the reviewer requests an explanation of good cause for late filing from the claimant while informing the other parties of the request for administrative review at the same time.

Field Offices (FOs) do not conduct administrative review under the fee agreement process. FO responsibilities in the process involve the following:

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  Properly routing any requests for administrative review that the FO may receive to the appropriate reviewing component (GN 03960.015).

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  Providing information about Title XVI cases, including the computation of the past-due benefits amount (GN 03960.043, GN 03960.045, and GN 03960.047).

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  Taking post-review actions in Title XVI cases (GN 03960.065).

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  Responding to inquiries from claimants, auxiliary beneficiaries, eligible spouses, and representatives.

However, a FO decision maker may request administrative review of the amount of the fee under an approved agreement (see GN 03960.010B.2. and C.). The FO decision maker may also comment on another party's request if it concerns the fee amount.