I-1-2-48.Administrative Review of the Amount of the Fee Under the Fee Agreement — Determination Notice Procedures

A. Prepare the Determination Notice

After following the procedures in Hearings, Appeals, and Litigation Law (HALLEX) manual I-1-2-46 and I-1-2-47, issue the notice of the fee amount determined after administrative review. Staff will use the appropriate notice templates in the Fee Action Tracking System (FAcTS) or Hearings and Appeals Case Processing System (HACPS) in the Office of Hearings Operations (OHO) or the Office of Appellate Operations Case Processing System (OAOCPS) in the Office of Appellate Operations (OAO) and the samples in HALLEX I-1-2-111 as needed.

The notice of the administrative review determination will include:

1. Authority for administrative review under the Social Security Act: section 206(a)(3) for Title II cases, and sections 206(a)(3) and 1631(d)(2) for Title XVI-only and concurrent cases.

2. Discussion of the issue(s) raised.

3. A statement as to whether the fee amount was affirmed or modified and the reasons.

4. The amount of the fee authorized after administrative review.

5. Instructions concerning any adjustment of the fee amount. If the fee is adjusted and:

   • If the eligible representative, or entity with a valid assignment as described in Program Operations Manual System (POMS) GN 03920.021, already received direct payment, include language that the effectuating component (processing center or field office) will inform the claimant, the representative, and, if there is a valid assignment, the entity's point of contact (POC) of the amount due to the representative or entity, or the amount the representative or entity must refund to the Social Security Administration (SSA), and the amount SSA will refund to the claimant.

     NOTE 1:

     The reviewing official does not calculate the outstanding amounts. The effectuating component will compute these amounts, taking into consideration any adjustments to the amount of the claimant's past-due benefits, the initially authorized fee, the initial user fee, the fee authorized after administrative review, and the user fee based on the authorized fee after administrative review.

     NOTE 2:

     If the fee is increased and the representative is an eligible representative who received the previously authorized fee from withheld benefits, or assigned direct payment of their fee to an entity that received the fee from withheld benefits, do NOT advise the representative and POC (if there is a valid assignment) that SSA will make the additional payment without first determining that the effectuating component is continuing to withhold the claimant's past-due benefits.

   • If the representative is not eligible for direct payment or waived direct payment, include language regarding the balance due to the representative or the amount the representative must refund the claimant, if the claimant has already paid the representative the fee amount initially authorized.

6. A statement that the determination is not subject to further review.

7. A statement that copies of the determination notice will be sent to the parties.

B. Distribute the Determination Notice

• Send copies of the determination notice to the claimant, any affected auxiliary beneficiary who does not reside with the claimant, and the representative at their last known addresses. The reviewing official must also mail a copy of the notice to the decision maker when the decision maker requested review or commented on the review.

  (See HALLEX I-1-2-46 C.1. for Privacy Act considerations.)

• Add a copy of the determination notice to the claim(s) file.

• As appropriate, send the determination notice to the component(s) that effectuated the favorable decision or alert the effectuating component that the determination notice is in the claim(s) file.

C. Systems Input

Update the case tracking system to reflect the administrative review determination.