I-1-2-109.Exhibit - Sample Acknowledgment Letters — Request for Administrative Review of Fee Resulting from Fee Agreement

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

  1. To Claimant - Requested Review

  2. To Representative - Did Not Request Review

  3. To Representative - Requested Review

  4. To Claimant and Other Parties - Did Not Request Review

A. To Claimant - Requested Review

I am writing about your letter dated (date). You asked me to review the fee amount we said your representative can charge for (his/her) work under your fee agreement.

What Will Happen

I will review the decision about the amount of the fee and make a new one. Based on that review, I will raise, lower or not change the fee amount your representative can charge.

If I lower the fee amount, the lower fee is the most your representative can charge under the fee agreement for (his/her) work on your Social Security claim. If I raise the fee amount, your representative can charge the higher amount.

Because (names of other parties, including representative and decision maker) can comment on your request for administrative review, I am sending them a copy of your request. They also can provide more information to me.

If I need more information, I will contact you. I will send you and the other people listed above, a letter telling what I decide.

If You Have Any Questions

If you have questions about this, please write me at the return address on this letter.

B. To Representative - Did Not Request Review

(Requester's name) has asked me to review the fee amount we said you can charge for your work on (claimant's name)'s claim for Social Security benefits. (He/She) wants me to lower the fee amount from $(amount) to $(amount).

What Will Happen

I will review the decision about the fee amount and make a new one. Based on that review I will raise, lower or not change the fee amount you can charge.

If I lower the fee amount, the lower fee is the most you can charge under the fee agreement for your work on (claimant's name)'s Social Security claim. If I raise the fee amount, you can charge the higher amount.

What You Can Do

I am sending you a copy of the (claimant's name)'s letter. If you have comments about the letter or want to give me more information, write me within 15 days. I will consider what you tell me. You can write me at the return address on this letter.

If You Have Any Questions

If you have questions about this letter, please write me at the above address.

C. To Representative - Requested Review

I am writing about your letter dated (date). You asked me to raise the fee amount we said you can charge for your work on (claimant's name)'s claim. You want me to raise the fee amount from $(amount) to $(amount).

What Will Happen

I will review the decision about the amount of the fee and make a new one. Based on that review, I will raise, lower or not change the fee amount you can charge.

If I lower the fee amount, the lower fee is the most you can charge under the fee agreement for your work on (claimant's name)'s Social Security claim. If I raise the fee amount, you can charge the higher amount.

Because (name of other parties, including decision maker) may comment on your request for administrative review, I am sending them a copy of your request. They also can provide more information to me.

If I need more information, I will contact you. I will send you and the other people listed above, a letter telling what I decide.

If You Have Any Questions

If you have questions about this, please write me at the return address on this letter.

D. To Claimant and Other Parties - Did Not Request Review

(Representative's name) has asked me to raise the fee amount we said (he/she) can charge for (his/her) work on your claim. (He/She) wants me to raise the fee amount from $(amount) to $(amount).

What Will Happen

I will review the decision about the fee amount and make a new one. Based on that review I will raise, lower or not change the fee amount your representative can charge.

If I lower the fee amount, the lower fee is the most your representative can charge under the fee agreement for (his/her) work on your Social Security claim. If I raise the fee amount, your representative can charge you the higher amount.

What You Can Do

I am sending you a copy of (representative's name)'s letter. If you have comments about the letter, or want to give me more information, write me within 15 days. I will consider what you tell me. You can write me at the return address on this letter.

If You Have Any Questions

If you have questions about this letter, please write me at the above address.