I-1-2-65.Fee Petition Administrative Review — Determination Notice

A. Policy

The reviewing official issues notice of the determination following administrative review, in the form of a letter, to the party who requested review of the initial fee authorization. The reviewing official sends copies of that letter to all other parties to the fee authorization. . This notice constitutes the formal and final decision of the Social Security Administration (SSA). It cannot be further appealed in SSA or in the courts.

B. Notice Content

Every notice of the decision following administrative review must include the following information:

• The authority under which the administrative review was conducted;

• The fee evaluation criteria used;

• An explanation of how the services were evaluated considering the evaluation factors (see HALLEX I-1-2-57 A);

• A statement of whether the amount of the initial fee was affirmed or modified and the reviewer's reasons for their action;

• The amount of the fee SSA authorized on review;

• An answer to all issues raised and decided during the administrative review;

• A statement that any undecided issue(s) is being considered and will be addressed at a later date by the appropriate component (e.g., SSA failed to certify direct payment of the initially authorized fee to an eligible representative or entity, if there is a valid assignment, because SSA did not withhold past-due benefits or prematurely released them);

• A discussion of the method of payment of the authorized fee (e.g., the claimant is responsible for payment of all or a portion of the authorized fee, or the representative must refund to the claimant and any affected auxiliary beneficiaries or SSA, as appropriate, any excess amount previously certified or paid);

  NOTE:

  If the reviewing official lowered the fee and the representative received direct payment from the claimant's past-due benefits, the processing center will advise the representative about refunding the excess fee and the claimant about additional benefits due.

• A statement that the Act and regulations do not provide for further review of the administrative review decision; and

• A statement that the other party(ies) (by name) will receive a copy of the administrative review decision letter.

Refer to I-1-2-116 and POMS GN 03950.065 for sample notices. These are examples and must be used with discretion. Representatives often have more than one case before SSA, and each case is different. Sending stock notices, without individualized rationales, would give the appearance of a pro forma review.

C. Releasing Notice of Administrative Review

The reviewing official's support staff will:

• Release the original determination to the individual who requested administrative review;

• Send copies of the determination to the other parties (see HALLEX I-1-2-41 B);

  NOTE:

  Because of Privacy Act considerations, the reviewing official will not reveal:

  • the claimant's personal information (e.g., mailing address or Social Security number (SSN)) when sending a copy of a letter addressed to the claimant, or the claimant's request for administrative review, to a party other than a representative; or

  • the auxiliary beneficiary's personal information (e.g., mailing address or SSN) when sending a copy of a letter addressed to the beneficiary, or the beneficiary's request for administrative review, to a party other than a representative.

This means the address and any other personal information must be covered before photocopying or completely blocked out before mailing.

• If there is an associated electronic record, the reviewing official or component will upload a copy of the notice of determination to the “B” section of eView or the Electronic Non-Medical Application (ENM). If the claim file is in ENM, staff should notify the effectuating component that the determination was uploaded into ENM and is available in the ENM claim(s) file.

• If the determination cannot be uploaded to eView or the Electronic Non-Medical Application (ENM), or if the claim file is paper, the staff will email a copy of the determination to the processing center (PC) and/or the field office (FO) responsible for effectuating the partially or fully favorable decision on the claim(s).