TN 19 (07-05)

A. Procedure - Notice Requirement

Although the title XVI system produces an automated fee agreement notice (throughout this section, we refer to the title XVI fee agreement notice as a “fee notice”) in many title XVI fee agreement cases, there are some situations that require a manual fee notice. These situations are listed in GN 03940.055B., Process - Manual Fee Notice Necessary. When the title XVI system does not produce an automated fee notice, the claims representative (CR) prepares a title XVI fee notice through the Document Processing System (DPS). Most fee agreement notice templates are in the Initial Claims/Fee Agreement category.

The notice will include information about the agreement approval or disapproval, fee authorization and/or fee payment, as the situation warrants. To select captions and paragraphs for a manual fee notice, follow the procedures in GN 03940.055 and in GN 03940.070B. through GN 03940.070E., except for the referral paragraph. Replace REF059 and REF064 with REF032 in title XVI manual notices.

When a manual notice is necessary only because the claimant was overpaid for a prior period of eligibility, follow the procedures in GN 03940.055 unless one of the situations addressed in this section also applies.

Refer to GN 03940.085 for the text of the fee captions and paragraphs.

B. Procedure - Title XVI Only - Favorable Decision - No Spouse Involvement

1. Fee Agreement Disapproved - Representative Eligible for Direct Payment - Past-Due Benefits Withheld for Possible Direct Payment

a. CR Disapproves Fee Agreement

When the CR disapproves the fee agreement at the initial or reconsideration level and the representative is eligible for direct fee payment, the CR prepares the disapproval notice.

Use UTI FEE038; caption ATYC08 and UTI FEE060; caption ATYC02, UTI ATY817, caption ATYC09, and UTI FEE093; caption ATYC03 and UTIs FEE035, FEE107, FEE108, FEE085 and FEE087 to notify the claimant and representative that:

• the fee agreement is disapproved and why;

• SSA is withholding the individual’s past-due benefits; and

• the representative should file a fee petition within 60 days if he/she wishes SSA to pay the fee directly to him/her.

b. ALJ or AAJ Disapproves Fee Agreement

When an Administrative Law Judge (ALJ) or an Administrative Appeals Judge (AAJ) disapproves a fee agreement at the hearing or Appeals Council review level, the CR does not prepare a disapproval fee notice because the CR is not the decision maker. In those claims, the ALJ or AAJ notifies the claimant and representative of the disapproved fee agreement. The CR does prepare a notice about withholding past-due benefits.

Use UTI FEE058; caption ATYC10 and UTI ATY045; caption ATYC03 and UTIs FEE035, FEE107, FEE108, FEE085 and FEE087, to notify the claimant and the representative that:

• SSA is withholding past-due benefits, and

• the representative should file a fee petition within 60 days if he/she wishes SSA to pay the fee directly to him/her.

2. Fee Agreement Approved - More than One Representative Receiving Direct Payment

When SSA is paying a fee to more than one representative, process the fee payments and the notice manually. Follow the procedures in GN 03940.055C.2. and GN 03940.055C.3., as the situation warrants, to prepare the notice, except replace the fee assessment UTI FEE047 with UTI FEE081.

C. Procedure - Title XVI Only - Favorable Decision - Spouse’s Past-Due Benefits May Be/Are Used to Calculate and/or Pay Fee

1. Fee Agreement Disapproved - Past-Due Benefits Withheld for Possible Direct Payment

a. CR Disapproves Fee Agreement

When the CR disapproves the fee agreement at the initial or reconsideration level, the CR prepares the disapproval notice manually through DPS.

Use UTI FEE038; caption ATYC08 and UTI FEE060; caption ATYC02, UTI ATY817, caption ATYC09, and UTIFEE093; caption ATYC10 and UTI ATY045; and caption ATYC03 and UTIs FEE035, FEE107, FEE108, FEE067, FEE085, and FEE087 to notify the claimant and representative that:

• the fee agreement is disapproved and why;

• SSA is withholding the individual’s past-due benefits and the individual’s spouse’s past-due benefits; and

• the representative should file a fee petition within 60 days if he/she wishes SSA to pay the fee directly to him/her.

b. ALJ or AAJ Disapproves Fee Agreement

Do not prepare a fee notice of the disapproval because you are not the decision maker. In those claims, the ALJ or AAJ notifies the claimant and representative of the disapproved fee agreement.

Use UTI FEE058, caption ATYC10 and UTI ATY045; caption ATYC03 and UTIs FEE035, FEE107, FEE108, FEE067, FEE085 and FEE087, to manually notify the claimant and the representative that:

• SSA is withholding the individual’s and the individual spouse’s past-due benefits, and

• the representative should file a fee petition within 60 days if he/she wishes SSA to pay the fee directly to him/her.

2. Fee Agreement Approved - Fee Authorized - No IAR

a. CR Approves Fee Agreement

When the CR approves the fee agreement at the initial or reconsideration level and authorizes a fee, send a manual notice.

Use UTI FEE038; caption ATYC06 and UTI ATY020; and caption ATYC10 and UTI FEE089.

• If the representative is not eligible for direct payment, use FEE022.

• If the representative is eligible for, but waived direct payment, use FEE033.

Use UTI FEE077.

• If the representative is eligible for and receiving direct payment, use caption ATYC03 and UTIs FEE035, FEE078, FEE080, and FEE047.

Also send a manual notice to the spouse. Refer to GN03940.070F.

b. ALJ or AAJ Approves Fee Agreement

When an ALJ or AAJ approves the fee agreement, the CR authorizes the fee and advises about fee payment through a manual notice.

Use UTI FEE038; caption ATYC10 and UTI FEE051.

• If the representative is not eligible for direct payment, use FEE022.

• If the representative is eligible for, but waived direct payment, use FEE033.

Use UTI FEE077.

• If the representative is eligible for and receiving direct payment, use caption ATYC03 and UTIs FEE035, FEE078, FEE080, and FEE047.

Also send a manual notice to the spouse. Refer to GN03940.070F.

3. Fee Agreement Approved - Fee Authorized Includes Spouse’s Past-Due Benefits - IAR - Direct Payment to Representative

Use UTI FEE038.

If the CR approves the fee agreement, use caption ATYC06 and UTI ATY020.

Use caption ATYC10.

• If the CR approves the fee agreement, use UTI FEE089.

• If an ALJ or AAJ approved the fee agreement, use UTI FEE051.

Use UTI FEE077 and caption ATYC03.

• If SSA is authorizing and paying the fee to the representative and paying the IAR at the same time, use UTIs FEE035, FEE078 and FEE041. Use UTI FEE043 (partial fee paid to representative), FEE044 (fee paid to representative, nothing left to pay claimant) or FEE045 (fee paid, remainder to claimant).

NOTE: UTI FEE042 is not an option because a portion of the fee is being paid from the spouse’s past-due benefits.

• If fee payment from the recipient’s withheld past-due benefits is delayed pending payment of the IAR, use FEE040 and FEE079.

Use UTI FEE047.

4. Fee Agreement Approved - Fee Authorization Based on Spouse’s Past-Due Benefits Delayed - No Interim Assistance Reimbursement (IAR)

a. CR Approves Fee Agreement

Use UTI FEE038; caption ATYC06 and UTI ATY020; caption ATYC10 and UTI FEE094.

• If the representative is not eligible for direct payment, use UTI FEE022.

• If the representative is eligible for, but waived direct payment, use UTI FEE033.

Use captions and UTIs ATYC02, FEE052, FEEC09, and FEE056.

• If the representative is eligible for direct payment, use caption ATYC03 and UTIs FEE035, FEE080 and FEE047.

b. ALJ or AAJ Approves Fee Agreement

Use UTI FEE038, caption ATYC10 and UTIs FEE003 and FEE094.

• If the representative is not eligible for direct payment, use UTI FEE022.

• If the representative is eligible for, but waived direct payment, use UTI FEE033.

Use captions and UTIs ATYC02, FEE052, FEEC09, and FEE056.

• If the representative is eligible for direct payment, use ATYC03 and UTIs FEE035, FEE080 and FEE047.

D. Procedure - Concurrent Titles II and XVI Claims - Favorable Decision - No Spouse Involvement - Fee Agreement Disapproved - Past-Due Benefits Withheld for Possible Direct Payment

For concurrent titles II and XVI claims, do not prepare a fee notice of the disapproval: the title II CR, ALJ or AAJ notifies the claimant and representative of the disapproved fee agreement. Because SSA is withholding the claimant’s past-due benefits for possible direct payment to the representative, it is necessary to manually notify the claimant and the representative that the representative should file a fee petition within 60 days if he/she wishes SSA to pay the fee directly to him/her.

Use UTI FEE058; caption ATYC10 and UTI ATY050.

Use caption ATYC03 and UTIs FEE035, FEE107, FEE108, FEE085 and FEE087.

NOTE: In this situation, the representative will receive a title II and a title XVI notice advising him/her to file the fee petition.

E. Procedure - Concurrent Titles II and XVI Claims - Favorable Decision - Fee Agreement Approved - Spouse Involvement

1. Fee Authorized - Title II Fee Amount Known - Representative Not Eligible for Direct Payment

When the SSR interface posts the title II fee information and the claimant’s and the spouse’s title XVI past-due benefits are known, authorize the title XVI fee and send a manual notice.

Use UTI FEE038, caption ATYC10 and UTIs ATY029 and FEE092.

• If the title II portion of the fee amount reduces the title XVI fee amount, use UTI ATY027.

Use UTI FEE022.

• If SSA is sending the claimant's first check to a State/subdivision based on an IAR agreement, use caption CHKC07 and UTI CHK002.

Use UTI FEE077.

2. Fee Authorized - Title II Fee Amount Known - Representative Eligible for Direct Payment

When the SSR interface posts the title II information, authorize the title XVI fee and send a manual notice.

Use UTI FEE038; caption ATYC10 and UTIs ATY029 and FEE092.

• If the title II portion of the fee amount reduces the title XVI fee amount, use UTI ATY027.

• If a representative is eligible for, but waives direct payment, use UTI FEE033.

Use UTI FEE077.

• If SSA has withheld past-due benefits for direct payment, use caption ATYC03 and UTIs FEE035 and FEE078.

• If SSA is making direct fee payment and there is no IAR involved, use UTI FEE080.

• If SSA is processing the fee payment after reimbursing the State agency for IAR, use UTIs FEE041 and FEE043 (partial fee paid to representative), FEE044 (fee paid to representative, nothing left to pay claimant) or FEE045 (fee paid, remainder to claimant).

Use the appropriate assessment paragraph.

• If the assessment deducted from the title II direct payment reduced the assessment on the title XVI payment, use UTI FEE048.

• If the maximum assessment was deducted from the title II direct payment, use UTI FEE049. (See GN 03920.019K. for further information about the assessment language in the notice.)

Also send a manual notice to the spouse. See GN 03940.070F.

3. Title II Fee Amount Unknown - Representative Eligible for Direct Payment

When the SSA decision maker approves the fee agreement, the title II fee is not known, and SSA is withholding title XVI past-due benefits pending fee authorization, send a manual notice.

Use UTI FEE038 and caption XVI719.

• If the title II CR approved the fee agreement, use UTI FEE062.

• If an ALJ or AAJ approved the fee agreement, use UTI ATY024.

Use caption ATYC03 and UTIs FEE035, FEE107, FEE108, FEE067 and FEE039.

F. Procedure - Notice To Spouse When Past-Due Benefits Withheld For Fee Payment - Fee Authorized

Issue a manual notice. Use UTI ATY019. In the first variable, use the name of the claimant who entered into the fee agreement.

Use caption ATYC10. In the first variable, use the name of the claimant who entered into the fee agreement.

Use FEE095, FEE080 and FEE077.

G. Procedure - Notice When Representative Is Eligible For Direct Payment But Waives A Fee

Issue a manual notice. Use UTIs FEE073 and FEE075.

H. References

Instructions on preparing a manual notice, NL 00801.000.

Paragraphs to use in a manual notice, GN 03940.085.