Fee and possible fee violations are those related to charging and collecting a fee.
A fee violation usually occurs when a representative collects a fee that we did not
authorize or collects a fee in excess of the amount we authorized. However, there
are other examples of a fee or possible fee violation in GN 03970.010.
When a question of a possible violation arises, use common sense and good judgment.
In some situations, a suspected violation might be a simple misunderstanding that
our technician can resolve with a contact. For example, a non-attorney selects the
wrong block on the SSA-1696 (Claimant's Appointment of a Representative) and mistakenly presents himself as an
attorney. After a brief phone call, the representative sends an amended SSA-1696 to correct the error, and our technician determines that the error was unintentional.
At other times, a contact may even rectify the violation. For example, a representative
received $1000 in excess of the fee we authorized. Upon notification by our technician,
the representative agrees to return the excess fee. In this case, and other suspected
fee violation cases (For example, direct payment errors, unauthorized fees, fees in
excess of the authorized amount), allow the representative reasonable time (or an
amount of time agreed to) to correct the problem. If at the end of that period, the
representative has not taken any action to correct the problem, develop and refer
fee and possible fee violations following the instructions outlined in this subsection.
In those cases where limited information is available, collect as much information
as possible. For sample notice language for duplicate or excess payments, refer to
GN 03970.025C.
NOTE: If the suspected violation is criminal or involves fraud do not contact the representative. For a possible non-fee violation (For example, representative
failed to provide competent representation), refer to GN 03970.010D.1. or GN 03970.010E.1, regarding whether to contact the representative.
However, you may contact a representative if the alleged violation relates to the
requirement for electronic filing or submission of evidence. You may do so prior to
referring the case to OGC to inform the representative of our rules and to ascertain
whether the alleged violation was a deliberate act or an oversight. When you believe
that a representative has violated the duty to assist the claimant to provide required
evidence, you can refer the matter to OGC pursuant to GN 03970.010D or GN 03970.010E.
Do not try to determine whether a representative’s conduct fits the exceptions in GN 03970.010B.2. IMPORTANT: Keep the information in a separate file. Never store referral development in the
claims file.
a. Request the claims file and proof of payment (check or direct deposit)
If there is a paper folder and it is not in the FO, request the claim file. If the
file is a certified electronic file (CEF), reference the eView or Claims Folder Records
Management System (CFRMS), or, in the office to which you are referring, the case
has no eView access, create a compact disc (CD) copy of the file according to the
instructions in DI 81001.035.
b. Request proof of payment
In cases where the payment of the fee is material and we have paid the representative
directly, you may view the Treasury Check Information System (“TCIS”), but do not
use it to obtain proof of payment. OGC will obtain proof of payment directly from
the Department of Treasury.
In cases where the claimant or beneficiary has paid the representative directly, ask
the claimant or beneficiary to provide you with proof of payment of the unauthorized
fee (For example, cancelled checks, credit card receipt, billing statement from the
representative, money order receipt, or a letter or note from the representative mentioning
the payment).
c. Complete form SSA-5002 (Report of Contact (RC))
Complete a report using an SSA-5002. Include a detailed description (Such as, answer questions such as who, what, when,
where, and how) of the violation. Use the following instructions to complete the report.
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1.
Identify who
Identify who (claimant, representative payee if applicable, representative, and witnesses)
is involved in or is a witness to the event that led to the violation.
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2.
Explain what
Explain the events (actions on the part of the representative and the claimant) that
led to the violation. For the different violation types, refer to the examples in
GN 03970.010. The following bulleted list are examples of the type of information needed in the
explanation:.
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•
Actions on the part of the representative include actions such as requesting and receiving
unauthorized fees;
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•
Actions on the part of the claimant include receiving the request for payment, paying
the fee, and receiving a receipt as proof of payment of the unauthorized fees;
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•
List what led the claimant to question the fees that the representative charged (For
example, the fee notice or another person’s input);
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•
Identify whether the fee was in addition to any fee(s) that we already authorized
or if fee collection was completely unauthorized;
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•
If we authorized the fee, indicate whether we authorized it through a fee petition
or a fee agreement;
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•
Determine and document whether the representative collected any money to recover costs
or expenses; and
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•
Determine and document whether the representative had a trust or escrow, agreement
with the claimant, or deposited any of the fee into a trust or escrow account. For
more information on escrow accounts, refer to GN 03920.025.
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3.
Identify when
Identify, as described in the following list, when the events took place:
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•
List the date the claimant received the billing statement or request for payment of
the unauthorized fee(s);
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•
If the fee was paid, determine the date the claimant or SSA paid the unauthorized
fee to the representative; and
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•
Indicate when the claimant realized that the appointed representative charged him
or her an unauthorized fee.
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4.
Identify where
Identify where the events took place (For example, the claimant’s home; the representative’s
office; a bank or check cashing facility; through the mail).
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5.
Explain how
Explain, as described in the following list, how the events took place:
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•
How much did the representative charge;
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•
How did the representative request the unauthorized fee (For example, orally or a
billing statement);
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•
How much did the claimant pay;
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•
If paid, how did the claimant pay (For example, cash; check; money order; credit card;
or provided a personal service for the representative);
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•
Who did the claimant pay; and
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•
How did the representative acknowledge payment (For example, issuing a receipt, sending
a letter or note mentioning the fee payment, or orally. If orally, is there a voicemail
message on the claimant’s or beneficiary’s phone.)
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6.
Identify Claimant, beneficiary, and representative
List the names, addresses, and telephones number of the representative, claimant,
or beneficiary.
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7.
Identify Witness(es)
List the name, address, and telephone number of any witness, indicating the witness's
relationship to the claimant, beneficiary, or the representative.
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8.
Identify FO point of contact
List the FO’s point of contact, including the contact’s name, title, and telephone
number (with the extension, if applicable).
d. Obtain copies of all documents
Obtain copies of any documents and any other evidence not already mentioned that support
the “who, what, when, where, and how” that you provided. For example, claimants or
beneficiaries often have letters or notes from the representative or voicemail recordings,
so provide a copy of the written communication or make a note of the oral communication
on an SSA-5002.
e. Obtain signed statements, if available
Obtain signed statements from any individual with direct knowledge of the facts involved,
including the claimant, beneficiary, payer, and any other witnesses. Do not contact the representative for a statement. The statements should provide all details
related to the events leading to the fee violation. If an individual will not cooperate
or sign a statement, record this information on an SSA-5002.
f. Documenting the claimant-representative relationship
If available, include in the file a copy of the notice of appointment (For example,
an SSA-1696 or another signed written equivalent); written and signed documentation of a fee
arrangement between the parties; or documentation that we recognized the individual
as the claimant’s representative such as a copy of the SSA-L1697 (Notice to Representative of Claimant Before the Social Security Administration).