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GN 03960.065: Postreview Actions Under the Fee Agreement Process - Title XVI

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  • Effective Dates: 05/15/2006 - Present
  • Effective Dates: 04/02/2018 - Present
  • TN 3 (03-95)
  • GN 03960.065 Postreview Actions Under the Fee Agreement Process - Title XVI
  • Process
  • 1. Decision Maker Disapproved the Fee Agreement
  • When the decision maker originally disapproved the fee agreement, postreview actions vary according to the reviewer's determination on administrative review.
  • NOTE: As used here, “reviewer” includes both ODAR and non-ODAR reviewing officials unless specified otherwise, e.g., “PC Reviewer.”
  • NOTE: As used here, “reviewer” includes reviewing officials at all levels 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. The PC reviewer places a copy of the determination in the claim(s) file and returns the file to the servicing FO.
  • b. Reviewer Approved the Fee Agreement
  • When the reviewer has reversed the initial determination and approved the fee agreement, the following occurs.
  • The PC reviewer places a copy of the determination in the claim(s) file and returns the file to the servicing FO. He/She annotates the Form SSA-559 (Transmittal Slip for Claims Folders): “Fee Agreement Approved - Title XVI CR to take the actions in GN 03960.065.1.b.”
  • The FO CR follows GN 03940.046 to determine the fee amount and, in concurrent cases, SI 02006.210 to adjust the title II income when the FO receives a copy of the claimant's notice showing the title II portion of the fee amount.
  • The FO CR also provides notice of the amount of the fee under the approved agreement and, if not done already, the past-due benefits amount.
  • 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 must seek approval under the fee petition process to charge and collect a fee.
  • a. PC Reviewer Actions
  • * When the representative submitted a form SSA-1560-U4 or an equivalent statement in connection with the request, the PC reviewer sends the material to the individual in the PC delegated the authority to authorize the representative's fee under the fee petition process (see GN 03930.001 ff.).
  • * When the representative has not submitted a form SSA-1560-U4 or equivalent statement, the PC reviewerplaces a copy of the determination in the claim(s) file and returns the file to the servicing FO. He /She annotates the Form SSA-559: “Fee Agreement Disapproved on Review - Title XVI CR follow the procedures outlined in GN 03960.065.2.b.”
  • b. FO Action When the Reviewer Disapproved the Fee Agreement
  • When the reviewer disapproved the fee agreement:
  • * No postreview action is necessary concerning the title XVI portion of the representative's fee.
  • * If the FO adjusted the title II income (following SI 00830.100 and SI 02006.210) but the claimant has not paid the amount of the fee authorized under the agreement, the FO CR readjusts the title II income to reflect that the claimant has not incurred expenses for representation.
  • * If the FO did not adjust the title II income or if the claimant has paid the amount of the fee authorized under the agreement, no postreview action is necessary concerning the title II portion of the representative's fee.
  • NOTE: Adjustment may later be necessary if SSA subsequently authorizes a fee under the fee petition process or the representative refunds the fee amount paid by the claimant under the fee agreement.
  • 3. Reviewer Affirms the Fee Under the Agreement
  • When the reviewer has affirmed the amount of the fee authorized under the agreement, the following occurs.
  • * PC Reviewer Actions
  • The PC reviewer places a copy of the determination in the claim(s) file and returns the file to the servicing FO. He/She annotates the Form SSA-559: “Fee Agreement Case - Fee affirmed on administrative review - Title XVI CR follow the procedures outlined in GN 03960.065.3.b.”
  • * FO Action When the Reviewer Affirmed the Fee for Services
  • * No postreview action is necessary concerning the title XVI portion of the representative's fee.
  • * If the FO adjusted the title II income (following SI 00830.100 and SI 02006.210), no postreview action is necessary.
  • * If the FO did not adjust the title II income, the FO CR follows SI 00830.100 and SI 02006.210 and adjusts the title II income to reflect the amount of the fee for both the titles II and XVI claims.
  • 4. Reviewer Modifies the Fee Under the Agreement
  • When the reviewer has modified the amount of the fee authorized under the agreement, the following occurs.
  • * PC Reviewer Actions
  • The PC reviewer places a copy of the determination in the claim(s) file and returns the file to the servicing FO. He/She annotates the Form SSA-559: “Fee Agreement Case - Fee modified on administrative review - Title XVI CR follow the procedures outlined in GN 03960.065.4.b.”
  • * FO Action When the Reviewer Modified the Fee for Services
  • * No postreview action is necessary concerning the title XVI portion of the representative's fee.
  • * The FO CR follows SI 00830.100 and SI 02006.210 and adjusts the title II income to reflect the amount of the fee for both the titles II and XVI claims.
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