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GN 03960: Administrative Review of Determinations Under the Fee Agreement Process

Effective Dates: 09/30/2005 - Present

TN 3 (03-95)

A. Introduction

Now that any necessary preliminary actions in GN 03960.020A.1. through A.3. are complete and you have received the request, begin administrative review. (Follow the instructions in GN 03950.001 ff., when SSA has authorized a fee under the fee petition process.)

B. Procedure

If SSA has authorized a fee under the fee agreement process, follow the steps below when reviewing a determination made about the fee under the agreement.

1. Establish Authority to Review

Confirm that you have authority to act on the request for administrative review. (See GN 03960.005 for jurisdiction.)

  • If you do not have authority, acknowledge receipt, unless that has been done already under GN 03960.015. Then refer the request to the correct office.

  • If you do have authority, obtain the claim(s) file. Then proceed to 2. below.

2. Examine the Claim(s) File and the Request

  1. Examine the claim(s) file and the request. Identify:

    • all parties;

    • the fee agreement;

    • the SSA-553 documenting the determination;

    • the notice of the fee determination;

    • any funds the representative may hold in a trust or escrow account;

    • any failure to withhold, or premature release of, title II past-due benefits; and

    • whether the case involves concurrent titles II and XVI claims or affected auxiliary beneficiaries (see GN 03960.043.).

  2. Screen the request for administrative review for:

    • timely filing;

    • filing by a proper party, i.e., a party who is affected by SSA's fee authorization (claimant, affected auxiliary beneficiary, representative or decision maker); and

    • the need for action on any other issue(s) the requester raised.

  3. Initiate any necessary development, by telephone or include your request for additional information in the acknowledgment letter. Ask for a response within 15 days and diary the case for 30 days.

  4. Proceed to 3. or 4. below.

3. Act on Late Filing With No Good Cause or Filing by Improper Party

  1. If any of the following apply, proceed to b. below. If they do not apply, proceed to 4. below.

    • A decision maker did not file timely. Either he/she failed to submit information with the request establishing good cause; or you do not find good cause for late filing based on the information the decision maker submitted with the request for administrative review.

    • A claimant, auxiliary beneficiary, or representative did not file timely, and you do not find good cause for late filing based on the explanation given. (GN 03960.025B.2. gives examples of good cause.)

    • An improper party requested administrative review.

  2. Follow GN 03960.070 to prepare the letter described below. Refer to GN 03960.085 for model letters.

  3. Send a letter telling the requester:

    • the reason(s) for deciding that he/she did not establish good cause or he/she is not a proper party;

    • SSA will not review the determination; and

    • the previous determination of the amount the representative may charge for his/her work in the case is final.

  4. Send copies to the other parties. Do not proceed with administrative review.

4. Consider the Approval of the Fee Agreement

  1. If disapproval of the fee agreement has been addressed previously on a request for administrative review, proceed to 5. below.

  2. Otherwise, consider whether the decision maker's approval of the agreement was correct, following GN 03960.040C.1.

    If the approval was correct, proceed to 5. below.

    If not, prepare a brief explanation of why you plan to disapprove the fee agreement and that if you do so, the representative must ask in writing for SSA's approval of the amount of the fee he/she wants to charge. However, if the representative has submitted a form SSA-1560-U4 or equivalent statement in connection with the request for administrative review of the amount of the fee, advise him/her that upon completion of our action we will consider such material under the fee petition process. Include the above in the letters described in 7. below, acknowledging receipt and notifying the other parties of the request for administrative review. Proceed to 7. below.

5. Check the Fee Amount Under the Terms of the Agreement

Proceed to 6. or 7. below when:

  • no party has disagreed with the calculation; and

  • there is no apparent error considering the $4,000 limit, the percentage specified in the agreement, and any other terms in the fee agreement.

Otherwise, follow GN 03960.040C.2.c. or d. and if necessary, GN 03960.045 and GN 03960.047 about recalculation.

If SSA revises its determination or decision about the amount of past-due benefits, follow GN 03960.045C. or GN 03960.047C.2. and curtail your review.

Otherwise, proceed to 6. or 7. below.

6. Consider the Standard a Decision Maker Must Meet

Consider the standard in GN 03960.040C.3.

  1. If you find evidence showing that either the representative did not represent the claimant's interest adequately or the fee is clearly excessive in light of the services provided, proceed to 7. below.

  2. If you do not find evidence of inadequate representation or a clearly excessive fee, take the following actions:

    • Follow GN 03960.070 to prepare the letter described below. Refer to GN 03960.085 for model letters.

    • If there is no apparent clerical error involved (see
      GN 03960.040C.2.), send a letter telling the decision maker that you did not find evidence of inadequate representation or a clearly excessive fee; that SSA will not review the determination further; and that the previous determination of the amount the representative may charge for his/her work in the case is final.

    • If there is an apparent clerical error involved, send a letter telling the decision maker that you did not find evidence of inadequate representation or a clearly excessive fee; that SSA will not review the determination further; and you are notifying the effectuating component(s) that an apparent clerical error has been made and that you request that it release a corrective notice(s) which includes new administrative review rights.

    • Send copies to the other parties. Do not proceed with administrative review. In the case of clerical error, notify the effectuating component(s) of the need for corrective action.

7. Provide Notice

Follow GN 03960.070 to prepare the letters described below. Refer to GN 03960.075 for model letters.

  1. Prepare the letter telling the requester that you:

    • received his/her request;

    • are notifying the other parties; and

    • will give them the opportunity to comment or submit additional information.

    Also advise him/her of any outstanding issues, such as:

    • untimely filing of the request for administrative review;

    • improperly approved fee agreement; or

    • incorrectly calculated amount of the fee.

  2. Prepare letters informing the other parties of the request for administrative review and what happens next. Advise the parties of any outstanding issues, such as those outlined above, and give them the opportunity to comment or submit additional information.

  3. Enclose a copy of the request for administrative review with each letter to the other parties.

  4. Send the letters and enclosures. Diary the case for 30 days.

  5. When the diary matures, proceed to:

    • GN 03960.057B.1. and 3., if you proposed to disapprove the fee agreement following 4.b. above and disapproval is proper;

    • GN 03960.057B.1. and 3., if GN 03960.040C.2.c. applies and you are modifying an incorrectly calculated fee amount;

    • 8. below, if you are ready to act on the requester's explanation for late filing;

    • 9. below, if you need to follow-up for information you requested; or

    • GN 03960.057, if the requester filed timely or you already decided he /she had shown good cause for late filing and none of the above applies.

8. Provide Subsequent Notice - Good Cause Question

Follow GN 03960.070 to prepare the letter(s) described in a. or b. below. Refer to GN 03960.080 for model letters.

  1. If the requester did not file timely and you received an explanation but have not decided the good cause question (in order to obtain further input as noted in GN 03960.025A.2.b.), prepare letters informing the other parties of the requester's explanation for late filing; that they may within 15 days comment in writing and submit relevant information; and that they will hear from you after you have decided whether the requester has established good cause. Proceed to c. below.

  2. Decide whether the requester has established good cause for late filing, if ready. (See GN 03960.025B.2. for examples of good cause.)

    If the requester has not established good cause, go to 3. above.

    If the requester has shown good cause, prepare letters to the requester and the other parties briefly explaining your finding; what happens on review; and that they may within 15 days comment in writing and submit relevant information.

    If you plan to disapprove the fee agreement, include the explanation 4.b. above describes.

    If you do not plan to disapprove the fee agreement include an explanation of the correct fee amount, if SSA incorrectly calculated the amount of the fee under the fee agreement; and, if GN 03960.040C.2.c. applies, that you will modify the amount of the fee if neither the requester nor any other party objects to the proposed modification during the comment period; or, if GN 03960.040C.2.d. applies, that you will consider the corrected fee amount when determining whether the fee is reasonable.

    If you expect to evaluate the representative's services (considering GN 03960.040C.2.d. and GN 03960.050), include the request GN 03960.050D.2. describes in the letter you prepare for the representative.

  3. Send the letters. Diary the case for 30 days.

  4. When the diary matures, proceed to:

    • b. above, if you have not yet decided the good cause question;

    • 3. above, if the requester has not established good cause for late filing;

    • 9. below, if you need to follow-up for information you requested; or

    • GN 03960.057, if you are ready to complete administrative review.

9. Follow-up for Outstanding Information

  1. Follow-up once by telephone or mail for any additional information you requested but have not received. Advise the party that if you do not receive it within 15 days, SSA will make its determination on the request for administrative review based on the information in file.

  2. Diary the case for 30 days.

  3. When you receive the information or the diary matures, proceed to:

    • 3. above, if the requester has not shown good cause for late filing;

    • 8. above, if you are ready to act on the requester's explanation for late filing; or

    • GN 03960.057, if you are ready to complete administrative review.

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GN 03950: Administrative Review of Fee Authorizations Under the Fee Petition Process
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GN 039: Representation and Representative's Fee
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GN 03970: Suspension or Disqualification of Representatives
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