I-1-2-110.Exhibit - Sample Interim Letters — Request for Administrative Review of Fee Resulting from Fee Agreement - Request Information on Services and Time Spent

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

  1. Representative Requested Review - To Representative

  2. Representative Requested Review - To Other Party

A. Representative Requested Review - To Representative

I am writing about your request that we review our decision on the fee agreement between you and (claimant's name).

If I cannot decide the fee amount based on the fee agreement alone, I will use the value of the services you gave (claimant's name) to decide on a fee amount.

To help me decide the value of your services, I need an explanation of the services you provided and the time you spent on (claimant's name)'s Social Security claim. Within 15 days, send a copy of the information to (claimant's name) and the original to 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.

B. Representative Requested Review - To Other Party

(Representative's name) has asked me to raise the fee amount we said (he/she) can charge under your fee agreement. (He/She) wants me to raise the fee amount from $(amount) to $(amount).

If I cannot decide the fee amount based on the fee agreement alone, I will use the value of (his/her) services to decide on a fee amount. To help me decide the value of (representative's name)'s services, I asked (him/her) to explain the services (he/she) provided and the time (he/she) spent on your Social Security claim.

I told (him/her) to send a copy of the information to you. If you have comments or want to give me more information, write me within 15 days of receiving the information. 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.