GN 03920.018: Direct Payment to Non-Attorney Representatives

changes
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~~Effective Dates: 01/12/2018 - Present~~
Effective Dates: 07/13/2018 - Present
TN 22 (01-18)
GN 03920.018 Direct Payment to Non-Attorney Representatives
A. Introduction to the Eligible for Direct Pay Non-Attorney (EDPNA) Policy
The Social Security Disability Applicants’ Access to Professional Representation Act of 2010, Public Law No. 111-142, permanently extends the fee withholding process to qualified non-attorney representatives who meet certain prerequisites. Refer to GN 03920.017 for the policy on payment of authorized representative’s fees.
NOTE: A non-attorney representative who is not eligible to receive direct payment must look to the claimant for payment of any fees authorized by SSA.
B. Prerequisites for becoming an EDPNA representative
Section 206(e) of the Social Security Act (Act) and 20 CFR §404.1717 and §416.1517 list the prerequisites that a non-attorney representative must satisfy in order to receive direct payment of fees.
1. EDPNA Application
The non-attorney representative needs to submit a timely, complete application before participating in the EDPNA program. We provide a four-week application period about three months prior to a scheduled examination. A contracted vendor manages the EDPNA program for us. We announce the open application period and provide a link to the contractor’s website on our non-attorney representatives page Representing Social Security Claimants - Direct Payment to Eligible Non-Attorney Representatives.
a. Application requirements
The non-attorney representative must download the application form SSA-1691 (SSA Eligible Non Attorney Representative) from the contractor’s website during the application period. The application form is only available during the open period.
The non-attorney representative must submit the completed application form SSA-1691 to the contractor before the end of last day of the application period.
If any portion of the application form is incomplete, the contractor will notify the non-attorney representative of the deficiency. The non-attorney representative will have 10 calendar days after the date we notify the representative of the deficiency to submit a new corrected application. If the applicant fails to timely submit a corrected, completed application during the prescribed timeframe, the applicant may re-apply in any subsequent year.
b. Payment for the examination
The non-attorney representative must submit a required fee along with the completed application. We set the examination fee annually.
We will refund the fee if:
* we do not administer an examination, and the non-attorney representative was unable to take the examination on the rescheduled date;
* circumstances beyond the non-attorney representative’s control that could not have been reasonably anticipated and planned for prevent the non-attorney representative from taking the scheduled examination; or
* the educational experience listed on the application form does not meet our educational requirements.
We will not refund the fee if the non-attorney representative:
* took the examination and failed;
* failed to arrive on time for the examination because of circumstances that could have been anticipated and planned for; or
* failed the background check.
2. Educational Requirements
The non-attorney representatives must demonstrate that they possess:
* a bachelor’s degree from an accredited institution of higher education; or
* a high school diploma or General Education Development (GED) certificate with four years of professional experience relevant to our programs.
We consider relevant professional experience to be work through which the non-attorney representative demonstrates familiarity with medical reports and the ability to describe and assess mental or physical limitations. The non-attorney representative may have gained this kind of experience in fields such as teaching, counseling or guidance, social work, personnel management, public employment service, nursing, or health care professions. We will also consider work involving claims for benefits under Titles II and XVI of the Act as relevant professional experience.
The non-attorney representative must have completed the education requirements prior to submitting an application; however, as noted in GN 03920.018B.5 in this section, we do not collect proof of educational and work experience certifications until after the representative passes the examination.
3. Background Check
The non-attorney representative must pass our criminal background investigation (including checks of our administrative records). Additionally, the non-attorney representative must attest under penalty of perjury that the non-attorney representative:
* is not a former attorney who has been suspended or disbarred from the practice of law in any jurisdiction;
* has not been suspended or disqualified from representing claimants before us;
* has not had a judgment or lien assessed against him or her by a civil court for malpractice or fraud;
* has not had a felony conviction; and
* has not misrepresented information provided on his or her application or supporting materials for the application.
4. Professional Liability Insurance
The non-attorney representative must provide proof of liability insurance coverage and maintain it. The policy must include a minimum coverage of $100,000 per incident for possible malpractice claims against the representative.
As noted in GN 03920.018B.5 in this section, proof of proper insurance must be provided after the representative passes the examination.
5. EDPNA Examination
The non-attorney representative must pass a written examination, administered by us, which tests knowledge of relevant provisions of the Act, the regulations, and our current policies and procedures.
We schedule our examination annually with the assistance of the contracted vendor. We announce the location of the examination on our website Representing Social Security Claimants - Direct Payment to Eligible Non-Attorney Representatives when we open the application period.
Upon passing the exam, the non-attorney must provide the vendor:
* educational and work experience certifications, as listed on the application form SSA-1691, and
* proof of liability insurance.
C. Continuing eligibility to participate in the program
To continue participation in this program, EDPNAs must meet ongoing continuing education requirements and must maintain proper insurance coverage. Failing to submit proof of either requirement will result in ineligibility to receive direct payment for at least six months.
1. Continuing education courses
Annually, the EDPNA must provide proof of completed continuing education requirements, which will include courses designed to enhance professional knowledge in matters related to disability insurance benefits under Titles II and XVI of the Act, as well as a qualified ethics and professional conduct course. The vendor will publish a list of the requirements at the beginning of each calendar year (January). The EDPNA must complete the courses by the end of the fiscal year (September) and send certification to the contractor within two weeks of the deadline.
2. Continuing insurance coverage
The EDPNA must provide to the contractor proof of liability insurance coverage by the end of each fiscal year.
D. Ineligibility and Protest procedures
We may find non-attorney representatives ineligible to participate in the direct fee payment program if they fail to meet any of the applicable criteria GN 03920.018B and GN 03920.018C, in this section. They can protest our finding of ineligibility if we based the finding on failure to:
* Attest to or provide sufficient documentation of the required education or equivalent qualifications.
We will find applicants ineligible to take the written examination if they do not include on the application educational or professional experience that meets our education requirement criteria. If they pass the examination, but fail to provide sufficient documentation of their educational and work experience as required, we will find them ineligible to participate in the direct fee payment program. Applicants may protest either of these findings.
If a non-attorney representative does not protest our ineligibility finding, or we uphold a protested ineligibility finding, the non-attorney representative may reapply for the examination in the following year.
* Meet at all times the criminal background investigation criteria
Non-attorney representatives who do not pass our background checks are ineligible for direct payment. If we cannot complete a background check prior to the examination date, we allow the applicant to sit for the examination; however, subsequent failure to pass a background check will lead to ineligibility, regardless of the examination results. Representatives may protest this finding. Ineligibility begins with the month after the month the protest period ends, or with the month after the month, we uphold our finding after a protest. A non-attorney representative who does not pass the background check or unsuccessfully protests our finding may not reapply to the EDPNA program.
* Provide documentation of both continuous liability insurance coverage and completed continuous education courses
We will find an EDPNA who does not meet the criteria for continuous insurance coverage or continuing education ineligible to receive direct fee payment for six full calendar months. EDPNAs may protest these findings. The ineligibility period begins with the month after the month the protest period ends, or with the month after the month, we uphold our finding after a protest. If the EDPNA does not protest our finding, we will uphold the 6-month ineligibility period.
In either case, the EDPNA may provide us with documentation that shows the required insurance coverage or satisfies the requirements for continuing education at any time. The EDPNA will again be eligible to receive direct fee payment beginning in the first month after the month we received sufficient documentation, but not earlier than the month following the end of the 6-month ineligibility period. We update the Non-Attorney Representatives List monthly to show who is eligible to receive direct payment.
If the non-attorney representative files a protest for any other reason, we will not recognize the protest and will implement our ineligibility finding as if the representative had not filed a protest.
A non-attorney representative who wants to protest our finding must file a protest in writing and provide all relevant supporting documentation to us within ten calendar days after the date we notify the representative of our ineligibility finding.
Our decision in response to a protest is final and is not subject to further review.
E. Verifying EDPNA status of non-attorney representative
We always check eligibility for direct payment at the time of payment. The technician must verify that the non-attorney representative is eligible for direct payment by reviewing the Non-Attorney Representatives List. We update the list monthly to show who is eligible to receive direct payment. If the non-attorney representative is not on the list or has an ineligibility status on the date we process the payment, the technician cannot pay the fee directly to the non-attorney representative. In these situations, the representative must request payment of the authorized fee directly from the claimant.
We always check eligibility for direct payment at the time of payment. The technician must verify that the non-attorney representative is eligible for direct payment by reviewing the EDPNA List in RASR. We update the list monthly to show who is eligible to receive direct payment. If the non-attorney representative is not on the list or has an ineligibility status on the date we process the payment, the technician cannot pay the fee directly to the non-attorney representative. In these situations, the representative must request payment of the authorized fee directly from the claimant.
* Verifying eligibility for direct payment
* Verify the claimant and non-attorney representative signed a Form SSA-1696 Claimant’s Appointment of Representative (or equivalent written statement); and
* Access the link Non-Attorney Representatives List to determine if the non-attorney representative is eligible for direct payment; and
* Access the link EDPNA List in RASR to determine if the non-attorney representative is eligible for direct payment; and
* Verify the non-attorney representative registered for direct payment with us.
You can also access the list in PolicyNet under “Tools and Resources.” For questions about the list, contact staff named. For more information on representative registration, see GN 03920.017B.3.
* Request for payment by ineligible non-attorney representative
If you determine that a non-attorney representative registered for direct payment using Form SSA-1699 (Request for Appointed Representative's Direct Payment Information) and submitted Form SSA-1695 (Identifying Information for Possible Direct Payment of Authorized Fees), but the non-attorney representative’s name is not on the Non-Attorney Representatives List, the direct payment link must be deleted. The technician will notify the non-attorney representative of the ineligibility for direct payment. Continue processing the claim to adjudication and release any past-due benefits to the claimant. If the non-attorney representative continues to submit SSA-1695s for direct payment in other claims, refer the non-attorney representative for a possible fee violation, per procedures in GN 03970.017B (FO) or GN 03970.017C (PC).
If you determine that a non-attorney representative registered for direct payment using Form SSA-1699 (Request for Appointed Representative's Direct Payment Information) and submitted Form SSA-1695 (Identifying Information for Possible Direct Payment of Authorized Fees), but the non-attorney representative’s name is not on the EDPNA List in RASR, the direct payment link must be deleted. The technician will notify the non-attorney representative of the ineligibility for direct payment. Continue processing the claim to adjudication and release any past-due benefits to the claimant. If the non-attorney representative continues to submit SSA-1695s for direct payment in other claims, refer the non-attorney representative for a possible fee violation, per procedures in GN 03970.017B (FO) or GN 03970.017C (PC).
A non-attorney representative who is not eligible for direct payment must look to the claimant for payment of any fee authorized and cannot be paid directly by us.
* Amending a notice of appointment after qualifying for direct payment
If a non-attorney representative submitted an appointment document, such as the form SSA-1696 (Claimant’s Appointment of Representative), before the representative became eligible for direct fee payment, the non-attorney representative must advise us of the change in direct payment eligibility status by submitting a properly signed supplemental Form SSA-1696 for each case in which the representative wishes to receive direct payment.
For the policy on supplemental appointments, refer to GN 03910.040B.3.
* Inquiries by non-attorney representatives about qualifying for direct payment
Direct non-attorney representatives who request more information on how to become eligible for direct payment to visit our Representing Social Security Claimants website.

POMS Reference

GN 03920.018: Direct Payment to Non-Attorney Representatives