I-1-1-40.Rules and Standards Governing the Conduct of Representatives

A. Affirmative Duties

As described in 20 CFR 404.1740(b) and 416.1540(b), a representative must:

1. Act with reasonable promptness to help obtain the information or evidence that the claimant must submit under SSA regulations, and forward the information or evidence to SSA for consideration as soon as practicable.

2. Assist the claimant in complying, as soon as practicable, with agency requests for information or evidence at any stage of the administrative decision-making process.

3. Conduct their dealings in a manner that furthers the efficient, fair, and orderly conduct of the administrative decision-making process.

4. Conduct business with SSA electronically at the times and in the manner prescribed on matters for which the representative requests direct fee payment.

5. Disclose in writing, at the time a medical or vocational opinion is submitted to SSA or as soon as the representative is aware of the submission, if:

   1. The representative's employee or any individual contracting with the representative drafted, prepared, or issued the medical or vocational opinion; or

   2. The representative referred or suggested that the claimant seek an examination from, treatment by, or the assistance of, the individual providing opinion evidence.

   NOTE 1:

   The agency must report to the Office of Management and Budget (OMB) the number of disclosures received pursuant to 20 CFR 404.1740(b)(5)-(9) and 416.1540(b)(5)-(9). To assist with disclosure reporting requirements, Office of Hearings Operations (OHO) and Office of Appellate Operations (OAO) staff will ensure that any disclosures described in this subsection (Hearings, Appeals, and Litigation Law (HALLEX) manual I-1-1-40 A.5.) are filed into the electronic claim(s) file (eView) using the document type “Required Disclosure – Medical (3076)” or “Required Disclosure – Vocational (1088),” depending on the type of evidence submitted with the disclosure.

   NOTE 2:

   A representative must submit a separate disclosure each time they submit opinion evidence that meets the requirements in 20 CFR 404.1740(b)(5) and 416.1540(b)(5) and described in this subsection. A single disclosure for multiple opinions that meet those requirements is not sufficient.

6. Disclose immediately if the representative discovers that their services are or were used by the claimant to commit fraud against SSA.

7. Disclose whether the representative is or has been disbarred or suspended from any bar or court to which they were previously admitted to practice.

8. Disclose whether the representative is or has been disqualified from participating in or appearing before any Federal program or agency.

9. Disclose whether the representative has been removed from practice or suspended by a professional licensing authority for reasons that reflect on their character, integrity, judgment, reliability, or fitness to serve as a fiduciary.

10. Ensure that all of the representative's employees, assistants, partners, contractors, or any person assisting the representative on claims for which the representative has been appointed, comply with the Rules of Conduct and Standards of Responsibility for Representatives, when the representative has managerial or supervisory authority over these individuals or otherwise has responsibility to oversee their work.

B. Prohibited Actions

As described in 20 CFR 404.1740(c) and 416.1540(c), a representative must not:

1. In any manner or by any means threaten, coerce, intimidate, deceive, or knowingly mislead a claimant, or prospective claimant or beneficiary, regarding benefits or other rights under the Act.

2. Knowingly charge, collect, or retain, or arrange to charge, collect, or retain from any source, directly or indirectly, any fee for representational services in violation of any applicable law or regulation.

3. Make, present, or participate in the making or the presentation of, false or misleading oral or written statements, evidence, assertions, or representations about a material fact or law concerning a matter within SSA's jurisdiction, in matters where the representative knows or should have known that those statements, evidence, assertions, or representations are false or misleading.

4. Through their own actions or omissions, unreasonably delay or cause to be delayed, without good cause, processing of a claim at any stage of the administrative decision-making process.

5. Divulge, without the claimant's consent, except as authorized by SSA regulations or other Federal law, any information SSA furnished or disclosed about a claim or prospective claim.

6. Attempt to influence, directly or indirectly, the outcome of a decision, determination, or other administrative action by any means prohibited by law, or by offering or granting a loan, gift, entertainment, or anything of value to a presiding official, agency or Disability Determination Service (DDS) employee, or witness who is or may reasonably be expected to be involved in the administrative decision-making process, except as reimbursement for legitimately incurred expenses or lawful compensation for the services of an expert witness retained on a non-contingency basis to provide evidence.

7. Engage in actions or behavior prejudicial to the fair and orderly conduct of administrative proceedings.

8. Violate any section of the Act for which a criminal or civil monetary penalty is prescribed.

9. Refuse to comply with any of SSA's rules or regulations.

10. Suggest, assist, or direct another person to violate SSA's rules or regulations.

11. Advise any claimant or beneficiary not to comply with any of SSA's rules or regulations.

12. Knowingly assist a person whom we suspended or disqualified to provide representational services before SSA or to exercise the authority of a representative described in 20 CFR 404.1710 and 416.1510.

13. Fail to comply with SSA's sanction(s) decision.

14. Fail to oversee the representative's employees, assistants, partners, contractors, or any other person assisting the representative on claims for which the representative has been appointed when the representative has managerial or supervisory authority over these individuals or otherwise has responsibility to oversee their work.

15. While serving as a point of contact (POC) for an entity, violate applicable affirmative duties, engage in prohibited actions, or conduct dealings with SSA in a manner that is untruthful or does not further the efficient and prompt correction of a fee error.

C. Sanctions Referrals and Proceedings

Under the regulations, the Commissioner or their designee may, after due notice and opportunity for a hearing, suspend or disqualify from practice as a representative before SSA any individual who:

• Does not meet the qualifying requirements described in 20 CFR 404.1705 and 416.1505;

• Has violated the affirmative duties of a representative or engaged in actions prohibited by the Commissioner's rules and regulations set forth in 20 CFR 404.1740 and 416.1540 and described in subsections A and B of this section;

• Has been convicted of a violation of section 206 or section 1631(d) of the Act;

Under 20 CFR 404.1770(a)(3)(ii) and 416.1570(a)(3)(ii), disqualification is the sole sanction available if a representative:

• Has been, for reasons of misconduct, disbarred or suspended from any court or bar to which they were previously admitted to practice;

• Has been, for reasons of misconduct, disqualified from participating in or appearing before any Federal program or Federal agency; or

• Has collected or received, and retains, a fee for representational services in excess of the amount authorized.

Staff in OHO or OAO will generally refer a representative's suspected misconduct using the procedures in HALLEX I-1-1-50. However, the Commissioner or designee may also refer alleged violations to the Office of the Inspector General for investigation and potential criminal prosecution or civil action. If OHO or OAO staff believes a criminal violation has occurred, (see the instructions in HALLEX I-1-3-3), they will follow the instructions in HALLEX I-1-3-6 or I-1-3-9, as appropriate. Refer to POMS GN 03970.013C for specific examples of prohibited conduct and violations of affirmative duties, and POMS GN 03970.013D for examples of criminal violations.

In addition to suspension or disqualification from providing representational services, a sanctioned individual may not serve as an entity's POC.

The rules and standards and the sanctions referral process apply only to individual representatives (including POCs) but not entities.