TN 41 (09-04)

(See GN 00506.010B. for application requirements.)

Document Identifier for Word Processor: E3941

A. EXHIBIT LETTER

SSA may authorize certain organizations to collect a fee for providing representative payee services to Social Security and Supplemental Security Income beneficiaries.

Qualified Organizations

An organization may qualify if it is regularly providing representative payee services to five or more beneficiaries and it is a:

• State or local government agency whose mission is to carry out income maintenance, social service or health care-related activities, or

• State or local government agency with fiduciary responsibilities, or

• community-based, non-profit social service agency bonded and licensed by the State in which it serves as representative payee.

Excluded Organizations

Creditors of the beneficiary generally may not collect fees for acting as representative payee. (An organization is a creditor of the beneficiary if it provides him or her goods or services and requires monetary compensation. For example, an organization collects a fee for counseling the beneficiary.)

However, in certain situations, a creditor can be authorized to collect a fee. Contact any local Social Security office for more information.

Amount of Fee

Organizations may collect a fee of up to 10 percent of the total monthly benefits, up to a maximum of $ (1) per month, from beneficiaries receiving disability benefits, if we have found they have a substance use disorder.

In all other cases, the organization may collect a fee of up to 10 percent of the total monthly benefits, up to a maximum of $ (2) per month.

It is illegal to charge or collect more than these amounts, and you may be fined or imprisoned for doing so.

Fill-ins:

1. maximum DAA condition amount

2. maximum non-DAA condition amount

B. REQUESTING INSTRUCTIONS

This is an enclosure to the Covering Letter to Qualified Organizations (NL 00703.940).

C. TYPING INSTRUCTIONS

The FO will send this notice using plain bond paper.