GN 03960: Administrative Review of Determinations Under the Fee Agreement Process
TN 3 (03-95)
Process
1. Decision Maker Disapproved the Fee Agreement
When the decision maker initially disapproved the fee agreement and the reviewer has affirmed or reversed that determination, postreview actions vary depending on the result.
NOTE: As used here, “reviewer” includes both OHO and non-OHO reviewing officials unless specified otherwise, e.g., “PC Reviewer.”
a. Reviewer Affirmed the Disapproval
When the reviewer has affirmed the disapproval of the fee agreement, the representative must seek approval under the fee petition process to charge and collect a fee. If the representative is a non-attorney, no postreview action is necessary.
If the representative is an attorney, thePC, for cases decided:
below the hearing level, follows GN 03930.045C.1., diarying the case for 60 days;
at or above the hearing level, follows GN 03930.045C.2., diarying the case for 150 days.
b. Reviewer Approved the Fee Agreement
When the reviewer reversed the initial determination and has approved the fee agreement, the BA:
Follows GN 03940.001E. to calculate the fee amount; and provides notice of the amount of the fee under the approved agreement, if not resolved already, the past-due benefits amount, and the right to request administrative review of the amount of the fee within 15 days of receiving this notice.
In a concurrent titles II and XVI case, he/she sends the servicing FO a copy of the claimant's notice showing the past-due benefits and fee amounts.
Recodes the Attorney Fee Data Line.
Diaries the case for 30 days for possible direct payment as GN 03940.025B.2. describes, if the representative is an attorney.
c. Reviewer Approved the Fee Agreement and Authorized the Fee Amount
When the reviewer reversed the previous determination, and has approved the fee agreement and authorized the fee amount, the PC:
In a concurrent titles II and XVI case, sends the servicing FO a copy of the claimant's notice on administrative review which shows the past-due benefits and fee amounts.
Recodes the Attorney Fee Data Line.
Diaries the case for 30 days for referral to a BA for possible direct payment as GN 03940.025B.2. describes, if the representative is an attorney.
2. Reviewer First to Disapprove the Fee Agreement
When the requester had disagreed with the amount of the fee under the agreement and the reviewer disapproved the fee agreement on administrative review, the representative seeks approval under the fee petition process to charge and collect a fee.
a. Representative Has Petitioned For Approval Of Fee
The reviewer sends the completed form SSA-1560-U4 or equivalent material to the individual in the PC delegated the authority to approve the representative's fee under the fee petition process (see GN 03930.001 ff).
b. Representative Has Not Petitioned For Approval Of Fee -Concurrent Titles II and XVI Case
In addition to the necessary PC action shown in c. or d. below, the PC reviewer:
annotates an Optional Form 41 (Routing and Transmittal Slip) or similar transmittal: “Fee Agreement Disapproved on Review - Title XVI CR to follow GN 03960.065.2.b.”; and
sends it to the servicing FO with a copy of the claimant's notice.
EXCEPTION: Information in the claim(s) file shows the claimant has paid the amount of the fee authorized under the agreement. In such a situation, the PC reviewerdoes not need to complete the Optional Form 41, but should send the servicing FO a copy of the claimant's notice on administrative review.
c. Non-attorney Representative
When the representative is a non-attorney, the PC recodes the Attorney Fee Data Line.
d. Attorney Representative
When the representative is an attorney, the PC recodes the Attorney Fee Data Line and for cases decided:
below the hearing level, follows GN 03930.045C.1., diarying the case for 60 days;
at or above the hearing level, follows GN 03930.045C.2., diarying the case for 150 days.
3. Reviewer Affirms the Fee Under the Agreement
When the reviewer has affirmed the amount of the fee authorized under the agreement, the need for further action depends on whether the representative is an attorney.
a. Non-attorney Representative
When the representative is a non-attorney, no postreview action is necessary.
b. Attorney Representative
When the representative is an attorney, the BA follows
GN 03940.025B.2. and:
certifies direct payment of the fee to the attorney from past-due benefits withheld;
releases any excess to the claimant; and
when there are one or more auxiliary beneficiaries, follows GN 03940.035.
NOTE: SSA immediately releases the remaining withheld past-due benefits to the claimant and affected auxiliary beneficiary(ies) after certifying direct payment of the fee to the attorney unless SSA must continue to withhold such benefits for additional fees awarded by the Federal court under §206(b) of the Act.
4. Reviewer Modifies the Fee Under the Agreement
When the reviewer has modified the amount of the fee under the agreement, the BA:
In a concurrent titles II and XVI case, follows GN 02610.053B.3. He/ She sends the servicing FO a copy of the claimant's notice of the determination on administrative review.
Recodes the Attorney Fee Data Line.
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When the representative is an attorney, follows
GN 03940.025B.2. and:certifies direct payment of the fee to the attorney from past-due benefits withheld;
releases any excess to the claimant; and
when there are one or more auxiliary beneficiaries, follows GN 03940.035.
NOTE: SSA immediately releases the remaining withheld past-due benefits to the claimant and affected auxiliary beneficiary(ies) after certifying direct payment of the fee to the attorney unless SSA must continue to withhold such benefits for additional fees awarded by the Federal court under §206(b) of the Act.