TN 3 (03-95)

A. POLICY

The following subsection provides models of the final letters described in GN 03960.035B.3.; GN 03960.037B.2.; GN 03960.055C.3. and 6.; and GN 03960.057B.3. Dictated letters should be prepared using these model letters as guides.

B. EXHIBITS

Letter AR-12

Final Letter - Request for Administrative Review Denied - Good Cause Not Established

Letter AR-13

Final Letter - Request for Administrative Review Denied - Improper Party Requested Review

Letter AR-14

Final Letter - Request for Review - Decision Maker Did Not Establish Evidence - Denied

Letter AR-15

Final Letter - Request for Review - Disapproval of Fee Agreement - Affirmation

Letter AR-16

Final Letter - Request for Review - Disapproval of Fee Agreement - Reversal

Letter AR-17

Final Letter - Request for Review - Fee Resulting From Agreement - Fee Agreement Disapproved

Letter AR-18

Final Letter - Request for Review - Fee Resulting From Agreement - Fee Not Changed

Letter AR-19

Final Letter - Request for Review - Fee Resulting From Agreement - Fee Raised

Letter AR-20

Final Letter - Request for Review - Fee Resulting From Agreement - Fee Lowered

AR-12 Final Letter - Request for Administrative Review Denied - Good Cause Not Established

George Bailey
Street Address
City/State/ZIP Code

On June 10, 1995, you asked us to review the fee amount we said your representative, Ms. Robin Bello, can charge for her work on your claim.

We asked you to explain why you did not ask us to review the fee amount within 15 days of our letter dated April 15, 1995.

Our Decision About the Late Request

• You said you did not get our notice of the fee amount until May 30, 1995. However, your local Social Security office says they talked to you about the fee notice on April 21, 1995. They told you then that you had to request review within 15 days of the date of our letter.

  You asked for a review more than 15 days after the date of our letter. We decided that the reason you gave us does not show you had a good reason for missing the deadline.

  So we will not review our final decision dated April 15, about the fee amount.

  We are sending copies of this letter to Robin Bello, Susy Bailey, Joey Bailey, and James Kelly.

If You Have Any Questions

• See Referral Paragraphs in Model Acknowledgment Letter AR-1

AR-13 Final Letter - Request for Administrative Review Denied - Improper Party Requested Review

John Jones
Street Address
City/State/ZIP Code

We are writing about your letter postmarked January 1, 1995. You asked us to review the fee amount we said Lynn Borden can charge for her work under the fee agreement with Fred Smith.

Our Decision

• We will not review our final decision dated December 21, 1995, about the fee amount under the fee agreement for the following reasons:

  • you were not involved in the decision made about the fee amount;

  • you do not represent Mr. Smith; and

  • your rights under the Social Security program were not affected by our decision.

    We are sending copies of this letter to Fred Smith, Lynn Borden, and James Kelly.

  If You Have Any Questions

  See Referral Paragraphs in Model Acknowledgment Letter AR-1

AR-14 Final Letter - Request for Review - Decision Maker Did Not Establish Evidence - Denied

James Kelly
Claims Representative
FO Street Address
City/State/ZIP Code

We are writing about your memorandum dated April 19, 1995. You asked us to review the $4,000 fee amount we said Marvin Levy can charge for his work under the fee agreement with Thurmond Thomas.

Our Decision

When the person who approved the fee agreement asks us to review the fee, he or she must show us that:

• the representative did not adequately represent the claimant's interest; or

• the fee is clearly too high for the representative's work on the claim(s).

You did not show us that either of these exists. ( Rationale for this conclusion .)

So we will not review our final decision dated April 5, 1995, about the fee amount. We are sending copies of this letter to Marvin Levy and Thurmond Thomas.

AR-15 Final Letter - Request for Review - Disapproval of Fee Agreement - Affirmation

Ellen Williams
Attorney at Law
Street Address
City/State/ZIP Code

We are writing about your request for administrative review of our decision about the fee agreement between you and Harry Henderson.

Our Decision

• Someone who did not make the first decision reviewed the fee agreement. Based on this review, we still cannot approve your fee agreement. This is because it (sets or may set) a fee that is more than (25 percent of past-due benefits) or ($4,000).

  We will not review this final decision.

If You Still Want To Charge A Fee

• If you still want to charge a fee, you must ask us in writing to approve the fee amount. You may use the enclosed Form SSA-1560-U4, “Petition to Obtain Approval of a Fee for Representing a Claimant Before the Social Security Administration,” to ask us to approve a fee.

  We have withheld 25 percent of Mr. Henderson's past-due benefits ($5,368). When we disapproved the fee agreement, we told you that, if you wanted us to pay your fee from withheld benefits, you should ask us to approve the fee within 60 days of the date of that letter.

  We do not wish to delay paying Mr. Henderson's withheld past-due benefits. Therefore, we will pay all past-due benefits to Mr. Henderson unless you ask us to approve the fee within 20 days of the date of this letter. You also may request an extension of time to file a fee petition. If you request an extension of time, you must do it in writing and send a copy of your request to Mr. Henderson.

  Please forward your petition for approval of a fee, request for an extension of time, or a statement that no fee will be charged to ( address of component delegated the authority to approve the representative's fee under the fee petition process ).

  We are sending a copy of this letter to Harry Henderson.

If You Have Any Questions

• See Referral Paragraphs in Model Acknowledgment Letter AR-1

AR-16 Final Letter - Request for Review - Disapproval of Fee Agreement - Reversal

James Stewart
Attorney at Law
Street Address
City/State/ZIP Code

We are writing about your request for administrative review of our decision about the fee agreement between you and Gregory Boyington.

Our Decision

• Someone who did not make the first decision reviewed the fee agreement. Based on this review, we now approve your fee agreement. This is because the agreement was given to us before we cedied to pay benefits to Mr. Boyington.

  We will base the fee amount on Mr. Boyington's past-due benefits. As soon as we decide the amount of past-due benefits, we will tell you the fee amount you can charge.

  We are sending a copy of this letter to Gregory Boyington.

If You Have Any Questions

• See Referral Paragraphs in Model Acknowledgment Letter AR-1

AR-17 Final Letter - Request for Review - Fee Resulting From Agreement - Fee Agreement Disapproved

Janice Brown
Street Address
City/State/ZIP Code

We are writing about your request to lower the fee amount we said your lawyer, Jane Doe, can charge under your fee agreement.

Our Decision

• When you requested that we lower the fee amount, we found that we should not have approved the fee agreement. This is because you and your lawyer did not both sign it.

  In our letter dated April 19, 1995, we said that we planned to disapprove your fee agreement. We gave you and your lawyer time to contact us and show us that you had both signed the fee agreement. Because we still do not have proof that you both signed, our decision to disapprove your fee agreement is now final.

If Your Lawyer Still Wants to Charge a Fee

• If your lawyer still wants to charge a fee, she must ask us in writing to approve the fee amount. She must also give you a copy of the fee request and each attachment to the request.

  We are sending a copy of this letter to Jane Doe.

If You Have Any Questions

• See Referral Paragraphs in Model Acknowledgment Letter AR-1

AR-18 Final Letter - Request for Review - Fee Resulting From Agreement - Fee Not Changed

Jane Doe
Attorney at Law
Street Address
City/State/ZIP Code

We are writing about your request to raise the fee amount we said you can charge Sally Brown under your fee agreement.

The law allows us to approve a representative's fee for social security claims-related services. The law also allows us to review decisions about the fee for those services.

Our Decision

• Someone who did not make the first decision reviewed the fee agreement. Based on this review, we decided that the $1,500 we approved before is reasonable for your services. We did not change the fee amount because ( Rationale for not modifying the fee, include response to specific issue(s) or argument(s) raised .)

  This is the most you can charge for your work on Sally Brown's Social Security claim. The fee does not include any out-of-pocket expenses (for example, costs to get copies of doctors' or hospitals' reports).

  There is no further review available to you, to Sally Brown, or to her children in this matter.

  We are sending copies of this letter to Sally Brown, Susy Brown, Joey Brown, and James Kelly.

If You Have Any Questions

• See Referral Paragraphs in Model Acknowledgment Letter AR-1

AR-19 Final Letter - Request for Review - Fee Resulting From Agreement - Fee Raised

John Jones
Attorney at Law
Street Address
City/State/ZIP Code

We are writing about your request to raise the fee amount we said you can charge James Smith under your fee agreement.

The law allows us to approve a representative's fee for social security claims-related services. The law also allows us to review decisions about the fee for those services.

Our Decision

• Someone who did not make the first decision reviewed the fee agreement. Based on this review, we decided that you may charge $2,000. We raised the fee amount because ( Rationale for increasing the fee, include a response to specific issue(s) and argument(s) raised .)

  This is the most you can charge for your work on James Smith's Social Security claim. The fee does not include any out-of-pocket expenses (for example, costs to get copies of doctors' or hospitals' reports).

  This decision replaces our earlier one about the fee amount dated November 19, 1995. This new amount is the most you can charge for your work on Mr. Smith's claim.

  We withheld $1,500 from Mr. Smith's past-due benefits. This amount is 25 percent of Mr. Smith's total past-due benefits. We will pay you $1,500.

  Payment of the rest of the fee is a matter between you and Mr. Smith. There is no further review available to you or to Mr. Smith in this matter.

  We are sending a copy of this letter to James Smith and James Kelly.

If You Have Any Questions

• See Referral Paragraphs in Model Acknowledgment Letter AR-1

AR-20 Final Letter - Request for Review - Fee Resulting From Agreement - Fee Lowered

Emily Harris
Street Address
City/State/ZIP Code

We are writing about your request to lower the fee amount we said your lawyer, Ms. Jones, can charge you under your fee agreement.

The law allows us to approve a representative's fees for social security claims-related services. The law also allows us to review decisions about the fee for those services.

Our Decision

• Someone who did not make the first decision reviewed the fee agreement. Based on this review, we decided that your lawyer may charge $1,000. We lowered the fee amount because ( Rationale for decreasing the fee, include a response to specific issue(s) and argument(s) raised .)

  This is the most your lawyer can charge for her work on your claim. The fee does not include any out-of-pocket expenses (for example, costs to get copies of doctors' or hospitals' reports).

  This decision replaces our earlier one about the fee dated February 15, 1995. Your lawyer can collect the fee as follows:

• We paid your lawyer $1,500 from your and your children's past-due benefits. The fee amount we now approve is $500 less than we paid. Your lawyer must refund $500. If you do not receive a refund soon, let us know.

  There is no further review available to you, to your children, or to Ms. Jones in this matter.

  We are sending copies of this letter to Joanna Jones, Mr. George Harris for Susy Harris and Joey Harris, and James Kelly.

If You Have Any Questions

• See Referral Paragraphs in Model Acknowledgment Letter AR-1