I-1-2-104.Exhibit - Fee Agreement Recommendation

Claimant's Name ____________________________________

Claim Number ____________________________________

Representative's Name ______________________________________

FEE AGREEMENT RECOMMENDATION
[Select the applicable bullet and check the basis or bases under the bullet, as necessary.]

I reviewed the fee agreement.

• The fee agreement meets the conditions for approval and none of the exceptions apply.

• The fee agreement does not meet the condition(s) for approval because:

  • The Social Security Administration did not receive the written fee agreement before making the favorable decision.

  • The claimant and the representative(s) (all) did not sign the fee agreement.

  • It sets a fee that is more than the lesser of 25 percent of the past-due benefits or $7,200 (e.g., the agreement sets a minimum fee).

• The fee agreement is excepted from the process because the following exception(s) applies:

  • The claimant appointed more than one representative from a law firm or other business; all representatives did not sign a single fee agreement; and the representative(s) who did not sign the fee agreement, did not waive charging or collecting a fee.

  • The claimant appointed representatives who are not members of the same law firm or other business, and the representative(s) from the other firm(s) or business(es) did not waive charging and collecting a fee.

  • The claimant discharged a representative or a representative withdrew from the case, before the claim was favorably decided, and that representative did not waive charging and collecting a fee.

  • The representative died before SSA issued a favorable decision.

  • A State court declared the claimant legally incompetent and the claimant's legal guardian did not sign the agreement.

I prepared for the AAJ's signature, an Appeals Council Order based on the above.

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Signature

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Date