Last Update: 1/28/03 (Transmittal I-1-44)
The reviewing official issues notice of the determination following administrative review, in the form of a letter, to the party who requested review of the initial fee authorization. The reviewing official sends copies of that letter to all other parties to the fee issue. This notice constitutes the formal and final decision of the Social Security Administration (SSA). It cannot be further appealed in SSA or in the courts.
Every notice of the decision following administrative review must include the following information:
the authority under which the administrative review was conducted;
the fee evaluation criteria used;
an explanation of how the services were evaluated in light of the evaluation factors;
a statement of whether the amount of the initial fee was affirmed or modified and SSA's reasons for doing so;
the amount of the fee SSA authorized on review;
an answer to all issues raised and decided during the administrative review;
a statement that any undecided issue(s) is being considered and will be addressed at a later date (e.g., SSA failed to certify direct payment of the initially authorized fee to an attorney because SSA did not withhold past-due benefits or prematurely released them);
a discussion of the method of payment of the representative's fee (e.g., the claimant is responsible for payment of all or a portion of the representative's fee, or the representative must refund to the claimant and the affected auxiliary beneficiary(ies) or SSA, as appropriate, any excess amount previously certified or paid);
If the reviewing official lowered the fee and the representative is an attorney who received direct payment from the claimant's past-due benefits, the processing center will advise the representative about refunding the excess fee and the claimant about additional benefits due him/her.
a statement that the Act and regulations do not provide for further review of the administrative review decision; and
a statement that the other party(ies) (by name) will receive a copy of the administrative review decision letter.
Refer to I-1-2-116 for sample notices. These are examples and must be used with discretion. Representatives often have more than one case before SSA and each case is different. Sending stock notices, without individualized rationales, would give the appearance of a pro forma review.
The reviewing official's support staff will:
release the original to the individual who requested administrative review;
send copies of the determination to the other parties;
Because of Privacy Act considerations, the reviewing official will not reveal:
the claimant's mailing address when sending a copy of a letter addressed to the claimant, or the claimant's request for administrative review, to a party other than a representative; or
the auxiliary beneficiary's mailing address when sending a copy of a letter addressed to the beneficiary, or the beneficiary's request for administrative review, to a party other than a representative.
This means the address must be covered before photocopying or completely blocked out before mailing.
place a copy of the determination in the Regional Office or hearing office file (or appeals file in the Office of Appellate Operations); and
send the determination and claim(s) file to the effectuating component(s).