Form Cms-1696-U4 - Appointment Of Representative (Page 2 of 2) in pdf

CHARGING OF FEES FOR REPRESENTING BENEFICIARIES BEFORE THE SOCIAL SECURITY ADMINISTRATION

An attorney, or other representative, who wishes, to charge

AUTHORIZATION OF FEE

a fee for services rendered in connection with a claim

The social security regulations contemplate that a

before the Social Security Administration is required by

representative will receive fair value for the services

law to obtain approval of the fee from the Social Security

performed before the Social Security Administration on

Administration or the Centers for Medicare & Medicaid

behalf of a claimant while at the same time giving a measure

Services (section 206(a) and 1631(d)(2) of the Social

of security to the beneficiaries. In approving a requested

Security Act; sections 404.1720 and 416.1520 of the Social

fee, the Social Security Administration or the Centers for

Security Administration Regulations Nos. 4 and 16,

Medicare & Medicaid Services considers the nature and type of

respectively). If the representative wishes to waive a fee or

services performed, the complexity of the case, the level of

to waive direct payment of the fee from past-due Social

skill and competence required in rendition of the services,

Security benefits, he may do so. Section III on the front of

the amount of time spent on the case, the results achieved,

this form can be used for that purpose.

the level of administrative review to which the

representative carried the claim and the amount of the fee

The form SSA-1560-U4, “Petition to Obtain Approval of a

requested by the representative. When a fee is authorized,

Fee for Representing a Beneficiary before the Social

both the representative and the claimant are notified and

Security Administration,” elicits the information required

allowed 30 days in which to request an administrative

to be submitted in support of fee petitions. It should be

review in case of disagreement.

completed by the representative after services are

completed and the original and the third carbon copy of the

CONFLICT OF INTEREST

SSA-1560-U4 filed with the office of the Social Security

Sections 203, 205 and 207 of Title XVIII of the United

Administration or the Centers for Medicare &

States Code make it a criminal offense for certain officers,

Medicaid Services which took the latest action on the

employees and former officers and employees of the

claim. The representative is required to furnish the

United States to render certain services in matters affecting

“Claimant’s/Beneficiary’s Copy” of the SSA-1560-U4

the Government or to aid or assist in the prosecution of

petition to the claimant for whom the services were rendered.

claims against the United States.

Social Security Administration approval of a fee is not

required where the fee is for services (1) rendered in an

official capacity such as that of legal guardian, committee,

or similar court-appointed office and the court has

approved the fee in question, (2) in representing the benefi-

ciary before a court of law, or (3) in representing the bene-

ficiary in a claim for reimbursement of medical expenses

exclusively handled by a private intermediary. Where a rep-

resentative has rendered services in a claim before the

Social Security Administration and a court of law, the reg-

ulations require that the amount of the fee to be charged, if

any, for services performed before the Social Security

Administration be specified. If any fee is to be charged for

such services, a petition for approval of that amount must

be submitted. In this connection a claim which has been

remanded by a court to the Social Security Administration

for further administrative proceedings is considered to be

before the Social Security Administration after the remand

by the court.

Form Cms-1696-U4 - Appointment Of Representative Page 2

Related Articles

Related forms

Related Categories