Last Update: 5/19/05 (Transmittal I-1-50)
The HO or Appeals Council Staff must review all incoming cases or materials to determine if the claimant is represented.
If the claimant is represented, the file should contain a completed Form SSA-1696, Appointment of Representative, or other written statement appointing the representative, signed by the claimant. When the claimant has appointed a non-attorney representative, the non-attorney representative must also sign the SSA-1696 or other written statement appointing the representative.
Upon receipt of a Form SSA-1696, the HO or Appeals Council staff will distribute and file the copies as appropriate; and enter or update the representative's name, address, and telephone number on case control documents and systems.
When the claimant appoints a representative, the HO or Appeals Council staff must attach a completed Form SSA-1128 (Representative Involved) to the outside lower right of the claim file. (See I-1-1-90 Exhibit - Form SSA-1128.) The SSA-1128 alerts the staff that a claimant is represented. In the processing centers (PCs) and FOs this helps to prevent processing errors by aiding staff to identify and correctly process cases involving representatives. It also serves to remind the PCs and/or FOs to:
withhold title II and/or title XVI past-due benefits when the claim involves a representative eligible for direct fee payment who has not waived collecting a fee or waived direct payment of a fee;
provide the representative a copy of all notices; and
diary the claim based on the information shown on the form.
When HO or Appeals Council staff determines that a claimant is represented, they must review the information identifying the representative and check the boxes on the Form SSA- 1128 as follows:
|
___ ATTORNEY |
___ NON-ATTORNEY ELIGIBLE FOR DIRECT PAYMENT |
___ NON-ATTORNEY INELIGIBLE FOR DIRECT PAYMENT |
(Determine whether the representative is an attorney, non-attorney eligible for direct payment, or non-attorney ineligible for direct payment and check the appropriate box. This information can be obtained from the “Acceptance of Appointment” section of the SSA-1696-U-4 (1-2005)
NOTE:
If the representative is a non-attorney who is not eligible for direct fee payment, do not complete the last seven blocks on the SSA-1128.
___ FEE AGREEMENT IN FILE
(Check this box if there is a fee agreement in file.)
|
___ APPROVED |
___ DISAPPROVED |
(When the decision is released and the decision is favorable, check either “Approved” or “Disapproved.”)
NOTE:
If the decision is unfavorable, the ALJ does not rule on the agreement and neither of these boxes is checked.
___ WITHHOLD DIRECT PAYMENT
(Check this box if the file does not indicate that the representative eligible for direct fee payment either waived a fee or waived direct payment of a fee. Also check this box if the file does not indicate that a third party will pay the entire fee.)
___ FEE WAIVED
(Check this box if the representative eligible for direct payment completed section III of the SSA-1696 or otherwise indicated that he or she waives a fee.)
___ DIRECT PAYMENT WAIVED
(Check this box if the representative eligible for direct fee payment completed section IV of the SSA-1696 or otherwise indicated that he or she waives direct payment of a fee.)
___TITLE II ONLY
(Check this box if the file indicates that it is a title II only claim.)
___ TITLE XVI (SSI) ONLY
(Check this box if the file indicates that it is a title XVI only claim.)
___CONCURRENT TITLES II AND XVI
(Check this box if the file indicates that this is a concurrent Title II and Title XVI claim.)
___ THIRD PARTY PAYMENT OF FEE
(Check this box if the file indicates that a third party will pay the fee.)