I-1-2-107.Exhibit - Sample Acknowledgment Letters — Request for Administrative Review of Fee Agreement Approval/Disapproval

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

  1. To Representative - Review Requester

  2. To Claimant - Did Not Request Review

A. To Representative - Review Requester

I am writing about your letter dated (date). You asked me to review the decision we made on the fee agreement between you and (claimant's name).

[If request was filed late and good cause found, summarize the reasons given for the late filing, e.g.:

When you asked me to review the (disapproval/approval) of the fee agreement, you said that you had a good reason for not asking me to review our decision within 15 days of the date you received our letter. You said that you were in the hospital until (date).

My Decision About the Late Request

I decided that you had a good reason for not asking for a review on time.]

What Will Happen

I will review the decision and make a new one. If I approve the fee agreement, we will tell you the most you can charge under the agreement for your services on the Social Security claim. If I do not approve the fee agreement and you want to charge a fee, you must ask us in writing to approve the fee amount.

Because (claimant's name) and the person who (disapproved/approved) the fee agreement can comment on your request for administrative review, I am sending them copies. They also can provide more information to me.

If I need more information, I will contact you. I will give you my decision in writing. I will also send copies of my decision to (claimant's name) and (decision maker's name).

If You Have Any Questions

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

B. To Claimant - Did Not Request Review

(Representative's name) has asked me to review our decision of (date), (disapproving/approving) a fee agreement between you and (him/her).

[If request was filed late and good cause found:

Although your representative did not submit the request within 15 days of receiving the determination on the fee agreement, (he/she) gave me (his/her) reasons for not filing on time. I have decided that (he/she) had a good reason for not asking for a review on time.]

What Will Happen

I will review the decision (disapproving/approving) the fee agreement and make a new one. I will give you that decision in writing. If I approve the fee agreement, we will tell you the most your representative can charge for (his/her) work on your claim. If I do not approve the fee agreement and your representative wants to charge a fee, (he/she) must ask us in writing to approve the fee amount.

What You Can Do

I am sending you a copy of your representative's letter. If you have comments about the letter or want to give me more information, write me within 15 days at the return address on this letter.

If You Have Any Questions

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