I-1-2-111.Exhibit - Sample Final Letters — Request for Administrative Review of Fee Amount Based on Approved Fee Agreement

Last Update: 2/25/05 (Transmittal I-1-48)

  1. Fee Agreement Disapproved - Claimant Requested Review

  2. Fee Not Changed - Representative Requested Review

  3. Fee Raised - Representative Requested Review

  4. Fee Lowered - Claimant Requested Review

  5. Decision Maker Requested Review - Basis to Review Not Established

  6. Decision Maker Requested Review - Fee Lowered and Letter Transmitting Final Letter to Representative

A. Fee Agreement Disapproved - Claimant Requested Review

I am writing about your request that we lower the fee amount we said your representative can charge under the fee agreement with you.

My Decision

In response to your request, I reviewed our prior decision and found that we should not have approved the fee agreement. This is because [reason for disapproval (e.g., you and your representative did not both sign it)].

In my letter dated (date), I said that I planned to disapprove your fee agreement. I gave you and your representative time to contact me and show me that you had both signed the fee agreement. Because I still do not have proof that you both signed, my decision to disapprove your fee agreement is now final.

There is no further review available to you, to your representative, or to (name(s) of the other party(ies) in this matter).

Authority for this Action

(Section 206(a)(3)/Sections 206(a)(3) and 1631(d)(2)) of the Social Security Act, as amended provide(s) the authority for me to review the original determination approving your fee agreement. In addition, (this/these) section(s) provide that my decision on the fee agreement is not subject to further review.

If Your Representative Still Wants to Charge a Fee

If your representative still wants to charge a fee, (he/she) must file a written petition asking us to approve the fee amount. (He/She) must also give you a copy of the fee request and each attachment to the request.

I am sending a copy of this letter to (representative's name).

B. Fee Not Changed - Representative Requested Review

I am writing about your request to raise the fee amount we said you can charge (claimant's name) under your fee agreement.

My Decision

I did not make the first decision about the fee amount. I did review that decision.

Based on this review, I have decided the $(amount) we approved before is reasonable for your services. I did not change the fee amount because (rationale for not modifying the fee, include response to specific issue(s) or argument(s) raised). This is the most you can charge for your work on (claimant's name)'s Social Security claim. The fee does not include any out-of-pocket expenses, for example, costs to get a doctor or hospital report.

There is no further review available to you, to (claimant's name), or to (name(s) of other party(ies) in this matter).

Authority for this Determination

(Section 206(a)(3)/Sections 206(a)(3) and 1631(d)(2)) of the Social Security Act, as amended provide(s) the authority for me to review the original determination on the amount you can charge (claimant's name) based on your fee agreement. In addition, (this/these) section(s) provide that my decision is not subject to further review.

I am sending copies of this letter to (names of other parties, including the decision maker).

C. Fee Raised - Representative Requested Review

I am writing about your request to raise the fee amount we said you can charge (claimant's name) under your fee agreement.

My Decision

I did not make the first decision about the fee amount. I did review that decision.

Based on this review, I have decided that you may charge $(amount). I raised the fee amount because (rationale for increasing the fee, include a response to specific issue(s) and argument(s) raise). This is the most you can charge for your work on (claimant's name)'s Social Security claim. The fee does not include any out-of-pocket expenses, for example, the cost to get a doctor or hospital report.

This decision replaces our earlier one about the fee amount dated (date). This new amount is the most you can charge for your work on (claimant's name)'s claim. There is no further review available to you or to (claimant's name) in this matter.

We are no longer withholding any of (claimant's name)'s past-due benefits. Therefore, payment of the difference between $(revised fee amount) and the fee amount we previously authorized (i.e., the fee amount authorized before we deducted the 6.3 percent user fee), is a matter between you and (claimant's name).

Authority for this Determination

(Section 206(a)(3)/Sections 206(a)(3) and 1631(d)(2)) of the Social Security Act, as amended provide(s) the authority for me to review the original determination on the amount you can charge (claimant's name) based on your fee agreement. In addition, (this/these) section(s) provide that my decision is not subject to further review.

I am sending a copy of this letter to (names of other parties, including the decision maker).

D. Fee Lowered - Claimant Requested Review

I am writing about your request to lower the fee amount we said your representative can charge you under your fee agreement.

My Decision

I did not make the first decision about the fee amount. I did review that decision.

Based on this review, I have decided that your representative may charge $(amount). I lowered the fee amount because (rationale for decreasing the fee, include a response to specific issue(s) and argument(s) raised). This is the most your representative can charge for (his/her) work on your claim. The fee does not include any out-of-pocket expenses, for example, the cost of a doctor or hospital report. This decision replaces our earlier one about the fee dated (date).

[If representative received direct payment]

This decision replaces SSA's (date) one about the fee amount. Based on this earlier decision, we paid your representative (his/her) fee from your (and your children's) past-due benefits. The fee amount I now authorize is less than we previously authorized; therefore, the (processing center with jurisdiction) will notify you and your representative how much your representative must refund to the Social Security Administration (SSA) and how much more SSA will send you.

[If representative did not receive direct payment]

If you have already paid your representative for his/her services, (he/she) should refund to you the difference between the amount you paid (him/her) and $(new maximum fee amount). If you do not receive a refund soon, let us know, as this could be a possible violation of Social Security laws and regulations.

There is no further review available to you (, to your children,) or to (representative's name) in this matter.

Authority for this Action

(Section 206(a)(3)/Sections 206(a)(3) and 1631(d)(2)) of the Social Security Act, as amended provide(s) the authority for me to review the original determination on the amount your representative can charge you based on your fee agreement. In addition, (this/these) section(s) provide that my decision is not subject to further review.

We are sending copies of this letter to (representative's name) and (names of other parties, including the decision maker).

E. Decision Maker Did Not Establish Evidence — Basis to Review Not Established

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

My Decision

When the person who approved the fee agreement asks me to review the fee, he or she must show me that:

  • the representative did not adequately represent the claimant's interest; or

  • the fee is clearly too high for the representative's work on the claim(s).

You did not show me that either of these conditions exists. (Rationale for this conclusion.)

So I will not review our final decision dated (date), about the fee amount.

I am sending copies of this letter to (names of other parties).

F. Decision Maker Requested Review - Fee Lowered and Sample Letter Transmitting Final Letters to Representative and Claimant

1. Letter to Decision Maker

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

My Decision

I did not make the first decision about the fee amount. I did review that decision.

I have decided that (claimant's name)'s (representative) may charge $(amount). I lowered the fee amount because (rationale for decreasing the fee: include a response to specific issue(s) and argument(s) raised). This is the most the (representative) can charge for (his/her) work on (claimant's name)'s claim. The fee does not include any out-of-pocket expenses, for example, the cost of a doctor or hospital report. This decision replaces our earlier one about the fee dated (date).

There is no further review available to you, (claimant's name), [(his/her) children,] or the claimant's representative in this matter.

Authority for this Action

(Section 206(a)(3)/Sections 206(a)(3) and 1631(d)(2)) of the Social Security Act, as amended provide(s) the authority for me to review the original determination on the amount the representative can charge based on (his/her) fee agreement with the claimant. In addition, (this/these) section(s) provide that my decision is not subject to further review.

I am sending copies of this letter to (claimant's name, names of other parties) and (his/ her/their) (representative), (representative's name). I am also advising them by separate letter that

  1. [if claimant paid representative] (the representative must refund the difference between the amount the claimant has already paid (him/her) and $(revised fee amount.)

  2. [if representative paid from past-due benefits] (the (processing center) will notify the representative about refunding the excess fee to the Social Security Administration and the claimant about additional benefits he/she is will receive because of the revised fee authorization).

Enclosure

2. Letter to Claimant

On (date), (Administrative Law Judge/Administrative Appeals Judge) (ALJ/AAJ's name) asked me to review the $(amount) fee amount we said your (representative) can charge for (his/her) work under the fee agreement with you. I decided that (he/she) may charge $(amount). The reasons for my decision are explained in the enclosed letter to Judge (ALJ/AAJ's name).

[If representative received direct payment]

Earlier we paid your representative $(total amount previously authorized as payable from past-due benefits MINUS 6.3 percent user fee) from your and your children's past-due benefits. This amount is the fee we approved before, less the service charge. The fee amount I now approve is less than the Social Security Administration previously authorized. The (processing center with jurisdiction) will notify you and your representative how much your representative must refund to the Social Security Administration and how much more we will send you because we lowered the fee your representative can charge.

[If representative did not receive direct payment]

If you have already paid your representative the fee we set earlier, (he/she) must refund $(difference between the two fee amounts) to you. This amount is the difference between the fee we previously set and $(fee set on administrative review).). If you do not receive a refund soon, let us know, as this could be a possible violation of Social Security laws and regulations.

I am sending a copy of this letter to your (representative) and the (Administrative Law Judge/Administrative Appeals Judge) who requested administrative review.