I-1-2-108.Sample — Determination Notices — Request for Administrative Review of a Fee Agreement Disapproval

A. Affirmation - Representative Requested Review

I am writing about your request for administrative review of our decision on the fee agreement between you and (name of claimant).

My Decision

I did not make the first decision about the fee agreement. I did consider that decision and I looked at the fee agreement. We still cannot approve your fee agreement because it [basis for disapproval (e.g., (sets or may set) a fee that is more than (25 percent of past-due benefits) or ($7,200))].

As provided in sections 206(a)(3) and/or 1631(d)(2) of the Social Security Act, as applicable, we will not review this final decision.

If You Still Want to Charge a Fee

If you still want to charge a fee, you must ask us in writing to approve the fee amount. You may use the enclosed Form SSA-1560-U4, “Petition to Obtain Approval of a Fee for Representing a Claimant before the Social Security Administration,” to ask us to approve a fee.

We have withheld $(amount), which was 25 percent of (name of claimant)'s past-due benefits. When we disapproved the fee agreement, we told you that if you wanted us to pay your fee from withheld benefits, you should ask us within 60 days of the date of that letter to approve the fee.

We do not wish to delay paying (name of claimant)'s withheld past-due benefits. Therefore, we will pay all past-due benefits to (name of claimant) unless you ask us within 20 days of the date of this letter to approve the fee. You may also request an extension of time to file a fee petition. If you request an extension of time, you must do so in writing within 20 days of the date of this letter and send a copy of your request to (name of claimant).

Please forward your petition for fee approval, request for an extension of time, or statement that you will not charge a fee to (address of component delegated the authority to approve the representative's fee under the fee petition process).

I am sending a copy of this letter to (name of claimant).

cc: (ALJ or AAJ who initially disapproved the fee agreement)

B. Reversal - Representative Requested Review

I am writing about your request for administrative review of our decision on the fee agreement between you and (claimant's name).

My Decision

I did not make the first decision about the fee agreement. I reviewed that decision and the fee agreement. I now approve the fee agreement. I decided that [basis for approving the agreement (e.g., the agreement was given to us before we decided to pay benefits to (claimant's name))].

We will base the fee amount on (claimant's name)'s past-due benefits. I am sending a copy of this letter to (claimant's name).

As provided in sections 206(a)(3) and/or 1631(d)(2) of the Social Security Act, as applicable, we will not review this final decision.

cc: (ALJ or AAJ who initially disapproved the fee agreement)