We are writing to tell you that the U.S. District Court for (1) approved a fee of $ (2) to pay your lawyer for the work on your claim while the court was reviewing it.
What We Will Pay Your Lawyer
Insert one of the following optional paragraphs:
3819 A (approved fee exactly equals withheld benefits):
We withheld the $ (1) from your benefits to pay your legal expenses. Since the court has approved the fee,
we are sending your lawyer this money. This means we have paid your lawyer in full
for the work on your claim while the court was reviewing it.
We are sending a copy of this letter to your lawyer.
3819 B (approved fee less than withheld benefits):
We withheld $1 from your benefits to pay your legal expenses. We will send $ (2) of this money to your lawyer. We are withholding the balance of $ (3) in case your lawyer asks us to approve a fee for work that was done before you decided
to take your case to court.
We are sending a copy of this letter to your lawyer.
3819 C (concurrent title II/XVI case subject to windfall offset)
Your SSI Payments May Change
Because we approved a fee in your Social Security claim, the amount of benefits we
used in figuring your SSI payments may change. Contact your local Social Security
Office to see if we can pay you more SSI money.
If You Have Any Questions
3901C - Domestic
3901D - Foreign