TN 13 (12-24)
Complete any necessary preliminary actions in GN 03960.020A.1. before processing the request for administrative review.
Follow the steps below when reviewing a fee agreement disapproval determination.
Confirm that you have authority to act on the request for administrative review. See GN 03960.005 for jurisdiction.
If you do not have authority, follow the instructions in GN 03960.015B to refer the request to the correct office. Do not proceed further in this section.
If you do have authority, obtain the claim(s) file, or ensure that it is an electronic record, then proceed to GN 03960.035B.2.
Identify:
All parties and the decision maker;
The fee agreement;
The Form SSA-553 (Special Determination) or other document listed in GN 03960.001A.7. documenting the determination; and
The notice of approval or disapproval of the fee agreement.
Screen the request for administrative review for:
Timely filing;
Filing by a proper party; and
The need for action on any other issue(s) the requester raised.
Initiate any necessary development, by telephone or include your request for additional information in the letter described in GN 03960.035B.4., which acknowledges receipt of the request for administrative review. Ask for a response within 15 days and diary the case for 30 days. Ensure that any oral conversations are documented in an SSA-5002 (Report of Contact) and that all materials related to development are associated with the claim(s) file.
Proceed to GN 03960.035B.3 or GN 03960.035B.4.
If the request was not filed timely and the requester did not establish good cause (see GN 03960.025B.2.), or the request was not filed by a proper party:
Follow GN 03960.070 to prepare the letter described in the following subsection. Refer to GN 03960.085 for model final notices.
Send a letter telling the requester:
The reason(s) for deciding that they did not show good cause, or they are not a proper party;
You will not review the determination; and
If the requester was a representative requesting review of a disapproved fee agreement, tell the representative that they must request approval of any fee they want to charge and collect using the fee petition process.
Send a copy to any other party.
If the requester was a representative requesting review of a disapproved fee agreement, enclose a Form SSA-1560 (Petition for Authorization to Charge and Collect a Fee for Services Before the Social Security Administration) with the letter sent to the representative. Do not proceed with administrative review.
Follow GN 03960.070 to prepare the letters in the following subsections. Refer to GN 03960.075 for model letters.
Prepare the letter telling the requester that you:
Received their request;
Are notifying any other party and the decision maker; and
Will give them the opportunity to comment or submit additional information.
If the requester filed timely or has established good cause for late filing, also explain what happens on review.
Prepare the letter(s) informing any other party of the request for administrative review and what happens next. If the requester:
Filed timely, explain to any other party what happens on review; and that they may, within 15 days, comment in writing and submit relevant information;
Did not file timely but they have established good cause for late filing, briefly explain to any other party your good cause finding; what happens on review; and that they may, within 15 days, comment in writing and submit relevant information;
Did not file timely and you received an explanation but have not decided the good cause question in order to obtain further input as noted in GN 03960.025A.2.b., inform any other party of the requester's explanation for late filing and explain that they may, within 15 days, comment in writing and submit relevant information, and that they will hear from you after you have decided whether the requester has shown good cause; or
Did not file timely and you are awaiting an explanation of the reason(s) for late filing, inform any other party that you are developing good cause and that they will hear from you again.
Enclose a copy of the request for administrative review with the letter(s) to any other party.
Send the letters and enclosure(s). Send a copy to the decision maker or email a notification to the decision maker to inform them the letter is available in the Online Retrieval System (ORS). Diary the case for 30 days.
When the diary matures, proceed to:
GN 03960.035B.5. below, if you are ready to act on the requester's explanation for late filing;
GN 03960.035B.6. below, if you need to follow-up for information you requested; or
GN 03960.037, if you are ready to complete administrative review.
Follow GN 03960.070 to prepare the letter described in GN 03960.035B.5.b. or GN 03960.035B.5.c. of this subsection. Refer to GN 03960.080 for model letters.
If the requester did not file timely and you received an explanation but have not decided the good cause question in order to obtain further input as noted in GN 03960.025A.2.b., prepare a letter informing any other party of the requester's explanation for late filing; that they may, within 15 days, comment in writing and submit relevant information; and that they will hear from you after you have decided whether the requester has established good cause. Proceed to GN 03960.035B.5.d.
Decide whether the requester has shown good cause for late filing. See GN 03960.025B.2. for examples of good cause. If the requester:
Has not established good cause, go back to GN 03960.035B.3.
Has established good cause, prepare letters to the requester and any other party briefly explaining your good cause finding; what happens on review; and that they may, within 15 days, comment in writing and submit relevant information.
Send the letter(s) and a copy to the decision maker, or email a notification to the decision maker to inform them the letter is available in ORS. Diary the case for 30 days.
When the diary matures:
Return to GN 03960.035B.5.c, if you have not yet decided the good cause question;
Return to GN 03960.035B.3, if the requester has not established good cause for late filing;
Proceed to GN 03960.035B.6., if you need to follow-up for information you requested; or
Proceed to GN 03960.037, if you are ready to complete administrative review.
Follow-up once by telephone or mail for any additional information you requested but have not received. Advise the party that if you do not receive it within 15 days, you will make a determination on the request for administrative review based on the information in the file.
Diary the case for 30 days.
When you receive the information or the diary matures:
Return to GN 03960.035B.3, above, if the requester has not established good cause for late filing;
Return to GN 03960.035B.5, if you are ready to act on the requester's explanation for late filing; or