I-1-2-103. Exhibit - Model Memorandum for ALJ/AAJ to Request Administrative Review of Fee Amount Based on an Approved Fee Agreement

Refer To:      

Regional Chief, Deputy Chief or Chief Administrative Law Judge

or

Deputy Chair or Chair, Appeals Council

_____-__-____, ____________________________________
Claim Number       Name of Claimant

_______________________________________
_______________________________________
Office of Disability Adjudication and Review

Request for Administrative Review of Fee Based on an Approved Fee Agreement — ACTION

I approved the fee agreement between (Name of claimant) and (his/her) representative, (Name of representative).

I ask for a reduction of the fee that would otherwise result under the agreement. I believe there is evidence that shows that:

[Designate one]

• (Name of representative) did not represent the claimant's interests adequately.

• the fee is clearly excessive in light of the services provided.

My reasons follow. _______________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

__________________________________           __________________
Signature                              Date

Attachment(s)   __ Yes         __ No

cc: ______________________, Claimant
    ______________________, Representative

Attorney Fee Branch, OAO, Office of Disability Adjudication and Review [if AAJ requests review]