I-1-2-119.Exhibit — ALJ or AAJ Rescinds the Fee Agreement Approval in the Subsequent Application and Disapproves the Fee Agreement

Last Update: 9/9/04 (Transmittal I-1-47)

On (date of favorable determination on subsequent application) the Social Security Administration notified you that you are entitled to and/or eligible for (type of benefits to which claimant is entitled/eligible). Based on the information available to the decision maker at that time, SSA also approved the fee agreement between you and your representative, (representative's name), on the basis that the agreement met all the statutory conditions for approval and was not excepted from the fee agreement process.

I must rescind this approval and disapprove the fee agreement because

[Only include those that apply]

HOW TO ASK US TO REVIEW THE FEE AGREEMENT DETERMINATION

You or your representative may ask us to review the determination on the fee agreement. If you decide to ask us for a review, write us within 15 days from the day you get this order. Tell us that you disagree and give your reasons. Send your request to this address:

[If Administrative Law Judge (ALJ) disapproved fee agreement:

Name and address of Regional Chief ALJ who has jurisdiction over the claimant's servicing hearing office. Refer to the OCALJ staff listing for this information.

If Administrative Appeals Judge disapproved fee agreement:

Social Security Administration
Office of Appellate Operations
ATTENTION: Attorney Fee Branch
5107 Leesburg Pike
Falls Church, VA 22041-3255]

Your representative also has 15 days to write us if he or she does not agree with the determination on the fee agreement.

You should include the social security number(s) shown on this order on any papers that you send us.

AUTHORIZING A REPRESENTATIVE'S FEE UNDER THE FEE PETITION PROCESS

If neither you nor your representative requests review, your representative must file a fee petition if he or she wants to charge and collect a fee. I have enclosed with the representative's copy of this order a Form SSA-1560 (Petition to Obtain Approval of a Fee for Representing a Claimant before the Social Security Administration) (he/she) may use for this purpose.

Signature
(Name and title of ALJ or AAJ)

Enclosure