I-1-2-101.Exhibit - ALJ or AAJ Approves the Fee Agreement— Language for the HA-515-U6 or HA-517-U9

Last Update: 1/28/03 (Transmittal I-1-44)

I approve the fee agreement between you and your representative subject to the condition that the claim results in past-due benefits.

My determination is limited to whether the fee agreement meets the statutory conditions for approval and is not otherwise excepted from the fee agreement process. I neither approve nor disapprove any other aspect of the fee agreement.

HOW TO ASK US TO REVIEW THE FEE AGREEMENT DETERMINATION

You or your representative may ask us to review the determination on the fee agreement. If you decide to ask us for a review, write us within 15 days from the day you get this order. Tell us that you disagree and give your reasons. Send your request to this address:

[If Administrative Law Judge (ALJ) approved fee agreement:

  • Name and address of Regional Chief ALJ in region where case was heard.

If Administrative Appeals Judge approved fee agreement:

Social Security Administration
Office of Disability Adjudication and Review
Office of Appellate Operations
ATTENTION: Attorney Fee Branch
5107 Leesburg Pike
Falls Church, VA 22041-3255]

Your representative also has 15 days to write us if he or she does not agree with the determination on the fee agreement.

You should include the social security number(s) shown on this order on any papers that you send us.

 

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