TN 6 (04-12)

A. Initial notification of suspended or disqualified representative or notification when representative continues to act as a representative

Dear:

We are writing to tell you that we no longer recognize John Doe, 123 Street, Anytown, New York 12345, as your representative. We have [suspended/disqualified] John Doe from representing claimants before us. [The suspension starts March 11, 2011, and lasts for 3 years./The disqualification starts March 11, 2011.] You did not cause John Doe’s [suspension/disqualification]. It will not affect how we decide your claim or any other matter that you have before us.

What Happens Next

You may wish to appoint someone else to represent you. Until you decide whether to appoint another representative, we will deal directly with you. We will help you with your claim(s).

John Doe may ask us for a fee for the services he gave you through [date suspension or disqualification began]. If he asks for a fee, we will let you review his request before we decide the fee amount that he may collect from you.

If You Have Questions

For general information about Social Security, we invite you to visit our website at www.socialsecurity.gov on the Internet. For general questions and specific questions about your case, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at 555-123-4567. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY/TDD number 1-800-325-0778. If you do call or visit an office, please have this letter with you. It will help us answer your questions.

                                                                                           Social Security Administration

cc:

Center for Program Support, Region ##

Office of the General Counsel, Region ##, or Office of General Law

B. Representative acts as the assistant to another representative

Dear:

We are writing to tell you that John Doe, who is an assistant to your representative, may no longer work on your claim. John Doe’s address is 123 Street, Anytown, New York 12345.

We have [suspended/disqualified] John Doe from representing claimants before us. [The suspension starts March 11, 2011, and lasts for 3 years./The disqualification starts March 11, 2011.] You did not cause John Doe’s [suspension/disqualification]. It will not affect how we decide your claim or any other matter that you have before us.

What Happens Next

Your representative, Jane Smith, may continue to represent you. However, your representative must not allow John Doe to work on any part of your claim. We cannot communicate with John Doe or accept correspondence from him.

If You Have Questions

For general information about Social Security, we invite you to visit our website at www.socialsecurity.gov on the Internet. For general questions and specific questions about your case, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at 555-123-4567. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY/TDD number 1-800- 325-0778. If you do call or visit an office, please have this letter with you. It will help us answer your questions.

                                                                                       Social Security Administration

cc:

Appointed Representative

Center for Program Support, Region ##

Office of the General Counsel, Region ##, or Office of General Law

C. Representative provides representational services through his or her employee

Dear:

We are writing to tell you that John Doe, the person your representative works for, may no longer work on your claim. John Doe’s address is 123 Street, Anytown, New York 12345.

We have [suspended/disqualified] John Doe from representing claimants before us. [The suspension starts March 11, 2011, and lasts for 3 years./The disqualification starts March 11, 2011.] You did not cause John Doe’s [suspension/disqualification]. It will not affect how we decide your claim or any other matter that you have before us.

What Happens Next

Your representative, Jane Smith, may continue to represent you. However, your representative must not allow John Doe to work on any part of your claim. John Doe cannot help you with or advise you about your claim. We cannot communicate with John Doe or accept correspondence from him.

If You Have Questions

For general information about Social Security, we invite you to visit our website at www.socialsecurity.gov on the Internet. For general questions and specific questions about your case, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at 555-123-4567. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY/TDD number 1-800- 325-0778. If you do call or visit an office, please have this letter with you. It will help us answer your questions.

                                                                                              Social Security Administration

cc:

Appointed Representative

Center for Program Support, Region ##

Office of the General Counsel, Region ##, or Office of General Law

D. Sanctioned representative attempts to get appointed or provide representational services, or for rejection of a notice of appointment due to character fitness or other reasons

Dear:

We are writing to tell you we are returning your notice of appointment. We cannot recognize John Doe, 123 Street, Anytown, New York 12345, as your representative. [We have suspended John Doe from representing claimants before us for 3 years./We have disqualified John Doe from representing claimants before us.] His [suspension/disqualification] will not affect how we decide your claim or any other matter that you have before us.

[Use this opening paragraph instead of the above if representative is unsuitable: We are writing to tell you we are returning your notice of appointment. We cannot recognize John Doe, 123 Street, Anytown, New York 12345, as your representative. John Doe does not qualify to represent claimants before us.]

What Happens Next

You may wish to appoint someone else to represent you. Until you decide whether to appoint another representative, we will deal directly with you. We will help you with your claim(s).

John Doe cannot charge a fee to you or anyone else who receives benefits on your record.

If You Have Questions

For general information about Social Security, we invite you to visit our website at www.socialsecurity.gov on the Internet. For general questions and specific questions about your case, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at 555-123-4567. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY/TDD number 1-800- 325-0778. If you do call or visit an office, please have this letter with you. It will help us answer your questions.

                                                                                            Social Security Administration

cc:

Center for Program Support, Region ##

Office of the General Counsel, Region ##, or Office of General Law