BASIC (12-81)

A. Prohibited Representation

A former SSA employee or official is prohibited forever from representing a claimant before SSA in any matter in which he had participated personally and substantially as an employee of SSA.

Personal and substantial participation is defined as: directly influencing by official recommendation, decision or adjudicative action, a claimant's eligibility to a benefit, payment or other right to which he may be entitled under the Social Security Act.

B. Restrictions on Representation

In addition to the above prohibition, a former SSA employee or official is prohibited for a period of 2 years after his employment has ended from representing a claimant in any claim the subject matter of which was actually pending under his official responsibility within his last year of employment.

“Actually pending” means that the claim or issue was referred to or under consideration by persons within the employee's area of responsibility.

“Official Responsibility” means the direct administrative or operating authority, whether intermediate or final and either exercisable alone or with others and either personally or through subordinates, to approve, disapprove or otherwise direct SSA's functions. Thus, any particular matter under consideration in SSA is under the official responsibility of the office director or office manager and under that of any intermediate supervisor having responsibility for an employee who actually participates in the matter within his position description.

The 2-year restriction on former employees seeking to represent claimants under the above criteria will, generally, apply to managerial personnel and those supervisory employees in whose area of responsibility the claim or issue is assigned and for whom, generally, there is no personal and substantial participation, as there is in the case of a claims representative, claims authorizer or disability claims examiner where personal involvement contributes significantly to the favorable or unfavorable determination.

The following examples are given to illustrate “personal and substantial participation” and “actually pending within the employee's area of responsibility.”

Example 1:

A former Claims Representative (CR) comes to a district office seeking approval to represent a claimant for disability insurance benefits (DIB). The claimant has not previously filed with SSA. The former CR may be accepted as the claimant's representative regardless of when his or her employment with SSA terminated.

In this case the former CR was representing a claimant who had never before filed a claim with SSA. There was no possibility of the former CR ever having participated personally and substantially in the matter as an employee of SSA.

On the other hand, had the CR been seeking to represent a DIB beneficiary in a continuing disability investigation (CDI) in which the CR as an SSA employee handled the initial DIB claim, he would be prohibited forever from representing the claimant in the issue of disability.

Example 2:

A former Operations Supervisor in a social security district office (DO) seeks approval to represent an RSI beneficiary claiming an earlier month of entitlement because of an earlier date of birth. The beneficiary submits primary evidence which was not known to exist when he filed his original claim. The original claim was filed 9 months previously in the same DO where the Operations Supervisor was employed at the time. However, the original claim was not assigned to the operational component over which the former employee was a supervisor. The former Operations Supervisor may be accepted to represent the beneficiary. While the initial claim was pending within the preceding 12-month period, it was not pending in the former employee's area of official responsibility; i.e., it was never subject to the direct operating authority of the Operations Supervisor or his subordinates. The 2-year restriction does not apply.

Example 3:

The situation is the same as example 2, except the former SSA employee was the District Manager. In the case of the District Manager, the initial claim was pending in his area of official responsibility within his last year of government employment. The 2-year restriction applies. The District Manager is prohibited from representing the beneficiary for a period of 2 years from the date his employment with SSA terminated.

C. Development — Former SSA Employees and Officials

1. General

The information that the prospective representative is a former SSA employee should be volunteered by the former employee, or it may be revealed in the development of the qualifications of a representative (GN 03910.030). Once it is determined that the prospective representative is a former SSA employee and his former position title warrants it, the DO, PSC or ODO will determine:

1. whether he ever personally and substantially participated in the matter as an SSA employee, and if not;

2. if he terminated his employment with SSA less than 2 years ago, and if so;

3. whether the matter was actually pending within the area of his official responsibility within his last year of employment with SSA.

This information should be recorded on an SSA-795 signed by the prospective representative.

2. Former Employee Qualifies As a Representative

If the former employee is not prohibited by the conflict-of-interest rules from representing the claimant, he shall be recognized as the representative of record if he otherwise qualifies and is properly appointed (GN 03910.040).

3. Former Employee Does Not Qualify As a Representative

If it is determined that the former employee is prohibited from representing the claimant before SSA, both the former employee and the claimant will be notified in writing. The notice will state that, under title 18 of the U.S. Code, section 207 and the implementing regulations (5 CFR, Part 737), the former employee is prohibited from serving as a representative before SSA and will not be recognized as the claimant's representative.

The claimant will also be informed that SSA will deal directly with him throughout the processing of his claim or until he appoints a successive representative (who is not prohibited from serving as a representative of claimants before SSA).

A copy of this notice will be placed in the claims folder. Should the former employee submit evidence or information in connection with the claim, it will be accepted by SSA; however, SSA will not communicate with the former SSA employee concerning such information or evidence. SSA may acknowledge receipt of such material by communication with the claimant or beneficiary or his subsequent representative.