TN 41 (09-04)

(GN 00506.130B.)

Document Identifier for Word Processor: E3945

A. EXHIBIT LETTER

Following is an explanation about fees for your services.

Amount of Fee

You may collect a fee of up to 10 percent of the total monthly benefits, up to a maximum of $59 per month, from beneficiaries receiving disability benefits, if we have found they have a substance use disorder. In all other cases, you may collect a fee of up to 10 percent of the total monthly benefits, up to a maximum of $31 per month.

If a beneficiary receives more than one payment in a month, these limits still apply.

Example:

A beneficiary receives both Social Security and Supplemental Security Income. The combined payments total $400. In this example, the maximum fee is $40 (10 percent) per month if the beneficiary is receiving disability benefits, if we have found they have a substance use disorder. . If not, the fee is $31 per month.

Funds That Cannot Be Used To Pay Fees

Fees for representative payee services cannot be paid from:

• A beneficiary's conserved funds (savings or checking accounts, bonds, etc.); or

• A personal needs allowance set aside for a Supplemental Security Income recipient.

When To Collect Fees

You can collect fees for any month in which your organization:

• is authorized by SSA to collect a fee; and

• receives a payment as representative payee for the beneficiary; and

• is not being paid by another source for providing the representative payee services.

You cannot collect fees for any month in which your organization:

• does not receive a payment for the beneficiary; or

• is the beneficiary's court-appointed guardian and is collecting a guardianship fee.

Applying to Be Representative Payee for Other Beneficiaries

If your organization wants to apply to be representative payee for another beneficiary and collect a fee for serving as representative payee, be sure that both of the following statements are in the “Remarks” section of the Form SSA-11-BK (Request to be Selected as Payee):

• “As an authorized organization, we will collect a fee for acting as this person's representative payee.”

• “We are/are not [enter whichever applies] a creditor of this individual.”

If you are a creditor and we select your organization, we will let you know whether you may collect the fees for services when you begin receiving the payments as representative payee. You may not collect the fees unless we authorize you to do so.

REPRESENTATIVE PAYEE RESPONSIBILITIES

Reporting Changes In Your Organization

All representative payees must report to SSA changes that could affect the amount of the beneficiary's payment or his or her entitlement to benefits. (Each time we select your organization to be representative payee for a beneficiary, we send you a pamphlet explaining the changes you must report.)

But, you must now also report any changes within your organization that may affect your authorization to collect a fee. Report these changes to the manager of the Social Security office that authorized your organization to collect a fee.

Accounting for Use of Benefits

Your organization must still use the remaining benefits for the beneficiary's personal care and well-being. Each time we select your organization to be representative payee for a beneficiary, we will send you a pamphlet explaining the proper use of benefits.

It is important that you keep accurate monthly records of how much you collect from each individual for representative payee services and how the remaining benefits were used. Your records must be available for our review at any time.

Every representative payee must periodically account to us for the use of benefits received for each beneficiary. When we need an accounting from your organization, we will send you a Form SSA-623-OCR-SM (Representative Payee Report) with instructions for completion.

When you complete the SSA-623-OCR-SM, you should include the fees for representative payee services on line 3C. This is the question that asks about money spent on things other than food or shelter, such as clothing, education, recreation and personal items.

B. REQUESTING INSTRUCTIONS

The FO will send this exhibit as an enclosure to the “Notice Authorizing Organization To Collect A Fee” (NL 00703.943).

C. TYPING INSTRUCTIONS

The FO will send this notice using plain bond paper.