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HALLEX I-1-101

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 1: General Subjects

Subject: Representation of Claimants

Chapter: I-1-100

March 17, 1995

Current through March 1997

I-1-101 REPRESENTATION OF CLAIMANTS: OVERVIEW (REVISED 03/95)

Citations: Social Security Act §§ 206(a) and (c), 1102 and 1631(d)(2) 20 CFR §§ 404.1700 - 404.1799, 410.684 - 410.699a, and 416.1500 - 416.1599 42 CFR §§ 405.701(c), 405.870, 405.872, and 498.10 - 498.13

A person claiming a right or benefit under titles II, XI, XVI, and XVIII of the Social Security Act (the Act), as amended, and under title IV of the Federal Mine Safety and Health Act of 1977, as amended, may appoint an attorney or other qualified individual to represent him or her in dealings with the Social Security Administration (SSA). If a claimant is declared legally incompetent, a duly appointed legal guardian may appoint a representative to pursue the claimant's rights before SSA. Also, parents may appoint a representative for a minor child unless the child is receiving benefits on his or her own behalf.

Section 206(a) of title II of the Act delegates broad authority to the Secretary to prescribe rules and regulations governing the recognition of attorneys and persons other than attorneys in representing claimants before SSA. The statute also specifically authorizes the Secretary to suspend or disqualify from further practice before SSA any person who does not comply with applicable rules and regulations.

· 20 CFR §§ 404.1706 and 416.1506 require that if a claimant is not represented by an attorney and SSA makes a determination or decision that is subject to the administrative review process and does not grant all of the benefits or other relief the claimant requested or that adversely affects any entitlement to benefits that SSA established or may establish for the claimant, SSA will include with the notice of that determination or decision information about the claimant's options for obtaining an attorney to represent the claimant in dealings with SSA. SSA must also advise the claimant that a legal services organization may provide the claimant with legal representation free of charge if the claimant satisfies the qualifying requirements applicable to that organization.


HALLEX I-1-102

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division I: General Subjects

Subject: Representation of Claimants

Chapter: I-1-100

June 30, 1994

Current through March 1997

I-1-102 QUALIFICATIONS OF REPRESENTATIVES

Citations: Social Security Act 206(a) and (b), 1102, and 1631(d)(2) 20 CFR §§ 404.1705, 410.685, and 416.1505 42 CFR §§ 405.871, 498.10

A. Attorney as Representative

A claimant may appoint an attorney in good standing as his or her representative in dealings before the Secretary. An attorney in good standing is one who--

1. has the right to practice law before a court of a State, Territory, District, or island possession of the United States, or before the Supreme Court or a lower Federal Court of the United States;

2. is not disqualified or suspended from acting as a representative in dealings before the Secretary; and

3. is not prohibited by any law from acting as a representative.

B. Non-attorney as Representative

A claimant may appoint a person who is not an attorney to be his or her representative in dealings before the Secretary if the person--

1. is generally known to have a good character and reputation;

2. is capable of giving valuable help to the claimant in connection with the claim;

3. is not disqualified or suspended from acting as a representative in dealings before the Secretary; and

4. is not prohibited by any law from acting as a representative.


HALLEX I-1-103

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 1: General Subjects

Subject: Representation of Claimants

Chapter: I-1-100

March 17, 1995

Current through March 1997

I-1-103 NOTIFYING CLAIMANTS WHO ARE NOT REPRESENTED BY AN ATTORNEY OF THE OPTIONS FOR OBTAINING REPRESENTATION (ADDED 3/95)

SSA field office (FO) staffs inform unrepresented claimants of the right, if they choose, to be represented. On request, FOs also provide more detailed information to claimants about representation, including lists of organizations which provide legal services free of charge to qualifying claimants. For this purpose, each FO maintains a list of lawyer referral services and legal service organizations which do not charge a fee for providing services. In addition, each FO periodically updates the address information on its list and sends a copy of the updated list to the hearing office (HO) which services the FO's service area.

The HO also maintains one or more lists of lawyer referral services and legal service organizations based on the lists provided by the FOs serviced by the HO. If the HO staff becomes aware that the information on a referral list (names, addresses, etc.) is inaccurate or out-of-date, the HO staff will update its copy of the list and send a copy of the corrected list to the appropriate FO so they may also update their list.

If an unrepresented claimant requests a hearing before an ALJ, the HO staff will send a representative referral list to the claimant with the acknowledgment letter. (Also see HALLEX I-2-020 C. and I-2-090, Sample 3.)


HALLEX I-1-110

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division I: General Subjects

Subject: Representation of Claimants

Chapter: I-1-100

June 30, 1994

Current through March 1997

I-1-110 APPOINTING THE REPRESENTATIVE

Citations: 20 CFR §§ 404.1707, 410.684, 416.1507 42 CFR §§ 405.870, 498.10

We will recognize as the claimant's representative a person who satisfies the qualifications set forth in section I-1-102--

- If the claimant signs a written notice of appointment; i.e., Form SSA-1696 (Appointment of Representative), designating that person as the claimant's representative in dealings before the Secretary;

- If the claimant designates a non-attorney and that person signs the notice of appointment agreeing to be the claimant's representative. An attorney does not have to sign a notice of appointment (but see Note 1, below); and

- If the claimant files the notice at an SSA office. The notice should be filed at a district office if the claim is at the initial or reconsideration level of adjudication; with an Administrative Law Judge (ALJ), if the claimant is requesting a hearing; or with the Appeals Council, if the claimant is requesting review of the ALJ's decision.

NOTE 1: Although the regulations do not require attorneys to sign notice of appointment forms, we strongly encourage the practice. By executing Form SSA-1696, the attorney certifies that he or she meets certain qualifications and will abide by the law and regulations governing fees. If the attorney does not sign Form SSA-1696, we still must receive some written acknowledgement, signed by the attorney, confirming his or her representation of the claimant.

NOTE 2: An organization may not represent a claimant. Thus, the claimant may not appoint as his or her representative a corporation, legal aid group or a law firm, but instead must specify a person or persons within the organization as the representative.

NOTE 3: In Medicare cases, an attorney's statement that he or she has the authority to represent the party will be accepted as sufficient evidence of appointment.


HALLEX I-1-111

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division I: General Subjects

Subject: Representation of Claimants

Chapter: I-1-100

June 30, 1994

Current through March 1997

I-1-111 DOCUMENTING APPOINTMENT OF REPRESENTATIVE (REVISED 11/92)

The Hearing Office (HO) or Appeals Council staff must review all incoming cases or materials to determine if the claimant is represented.

A. Use of SSA-1696

If the claimant is represented, the file should contain a completed Form SSA-1696, Appointment of Representative, or other written statement appointing the representative, signed by the claimant. When the claimant has appointed a non-attorney representative, the non-attorney representative must also sign the SSA-1696 or other written statement appointing the representative.

Upon receipt of a Form SSA-1696, the HO or Appeals Council staff will distribute and file the copies as appropriate; and enter or update the representative's name, address, and telephone number on case control documents and systems.

B. Use of SSA-1128

When the claimant appoints a representative, the HO or Appeals Council staff must attach a completed Form SSA-1128 (Representative Involved) to the outside lower right of the claim file. (See I-1-190 Samples: Sample SSA-1128.) The SSA-1128 alerts staff that a claimant is represented. In the processing centers (PCs) and field offices (FOs) this helps to prevent processing errors by aiding staff to identify and correctly process cases involving representatives. It also serves to remind the PCs and/or FOs to:

- withhold title II past-due benefits when the claim involves an attorney representative who has not waived collecting a fee or waived direct payment of a fee;

- provide the representative a copy of all notices; and

- diary the claim based on the information shown on the form.

C. Completion of Form SSA-1128

When HO or Appeals Council staff determine that a claimant is represented, they must review the information identifying the representative and check the boxes on the Form SSA-1128 as follows:

[ ] ATTORNEY

[ ] NON-ATTORNEY

(Determine whether the representative is an attorney or non-attorney, and check the appropriate box.)

NOTE: If the representative is not an attorney, do not complete the last five blocks on the SSA-1128.

[ ] FEE AGREEMENT IN FILE

(Check this box if there is a fee agreement in file.)

[ ] APPROVED

[ ] DISAPPROVED

(When the decision is released and the decision is favorable, check either "Approved" or "Disapproved.")

NOTE: If the decision is unfavorable, the ALJ does not rule on the agreement and neither of these boxes is checked.

[ ] WITHHOLD DIRECT PAYMENT

(Check this box if the file does not indicate that the attorney either waived a fee or waived direct payment of a fee. Also check this box if the file does not indicate that a third party will pay the entire fee.)

[ ] FEE WAIVED

(Check this box if the attorney completed the top part of section III of the SSA-1696 or otherwise indicated that he or she waives a fee.)

[ ] DIRECT PAYMENT WAIVED

(Check this box if the attorney completed the bottom part of section III of the SSA-1696 or otherwise indicated that he or she waives direct payment of a fee.)

[ ] TITLE XVI (SSI) ONLY

(Check this box if the file indicates that it is a title XVI only claim.)

[ ] THIRD PARTY PAYMENT OF FEE

(Check this box if the file indicates that a third party will pay the fee.)


HALLEX I-1-120

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division I: General Subjects

Subject: Representation of Claimants

Chapter: I-1-100

June 30, 1994

Current through March 1997

I-1-120 AUTHORITY OF A DULY APPOINTED REPRESENTATIVE (REVISED 11/92)

Citations: 20 CFR §§ 404.1710, 404.1715, 410.686, 416.1510, and 416.1515

42 CFR §§ 405.872, 498.11

A. Actions a Representative May Take

A duly appointed representative may, on the claimant's behalf:

1. Obtain information about the claim which we would normally provide the claimant;

2. Examine any documents to which the claimant would have access;

3. Appear at a hearing either alone or with the claimant;

4. Present and object to the introduction of evidence;

5. Present the claimant's contentions and position on any issue;

6. Cross-examine witnesses;

7. Make statements concerning the facts and law;

8. Submit briefs or other written statements; and

9. Make any request or give any notice about the proceedings before the Secretary.

B. Actions a Representative May Not Take

A duly appointed representative may not:

1. Sign an application for rights or benefits on behalf of a claimant, except under the criteria specified in 20 CFR §§ 404.612, 410.222, and 416.315;

2. Testify in place of the claimant.

C. Contact with Claimant and Representative

1. Consistent with the claimant's authorization for the representative to act on his or her behalf, we must contact the claimant through the representative unless we have the representative's permission to contact the claimant directly.

2. We must send all administrative notices and requests for information to both the claimant and the representative as follows:

- At the administrative adjudicatory level, i.e., ALJ hearing and Appeals Council review, direct all notices, orders, and decisions to the claimant, with a copy to the representative. During the pendency of a civil action in Federal court, send all notices, orders, and decisions to the representative with a copy to the claimant.

- Direct all requests for information to the representative, with a copy to the claimant, unless the representative requests orally or in writing that we send them directly to the claimant.

- Proffer evidence received after the administrative hearing directly to the representative with a copy to the claimant. (See sections I-2-528, Action Following Receipt of Requested Evidence, I-2-544, Action When Responses to Interrogatories are Received, and I-2-730, Proffer Procedures.)


HALLEX I-1-130

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division I: General Subjects

Subject: Representation of Claimants

Chapter: I-1-100

June 30, 1994

Current through March 1997

I-1-130 TERMINATION OF A REPRESENTATIVE'S APPOINTMENT

A. When a Representative's Appointment Ends

We will withdraw our recognition of a person as a claimant's representative when:

1. the claimant dismisses the representative and revokes his or her authority;

2. the representative advises SSA that he or she has withdrawn from the case;

3. the matter giving rise to appointment of the representative has been disposed of by a final decision or other final action; or

4. the representative has been suspended or disqualified by issuance of a final order and decision.

NOTE: If there is reason to suspect that a representative is suspended or disqualified from representing claimants, contact the Regional Chief ALJ (RCALJ). If the RCALJ has no information, the RCALJ will refer the inquiry to the Special Counsel Staff in Headquarters.

B. Claimant Revokes Representative's Appointment

A claimant may revoke a representative's appointment at any time. If the claimant revokes the appointment orally, the employee to whom the statement is made must document the conversation and ask the claimant to submit a signed statement confirming the termination of appointment. Place copies of both documents the termination of appointment. Place copies of both documents in the claim file and update case control documents and systems. Copies should also be placed in the hearing office file if the revocation was made at the hearing level, or in the Appeals Council working file if the revocation was made at the Appeals Council level.

NOTE: When the claimant revokes the representative's appointment or the representative's authority has expired, do not disclose any information to the representative without the claimant's prior written consent.

C. Former Representative's Fee For Services

A former representative may be authorized a fee for services he or she performed on the claimant's behalf before the date the appointment was terminated. Refer to Chapter I-1-200.


HALLEX I-1-140

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division I: General Subjects

Subject: Representation of Claimants

Chapter: I-1-100

June 30, 1994

Current through March 1997

I-1-140 RULES GOVERNING THE CONDUCT OF REPRESENTATIVES

Citations: Social Security Act §§ 1102(a), 206(a) and 1631(d)(2) 20 CFR §§ 404.1740, 404.1745, 410.687, 410.688 416.1540 and 416.1545

The Social Security Act authorizes the Secretary to make and publish such rules and regulations as may be necessary to discharge the Secretary's duties under the Act. To implement the Act's provisions regarding representation of claimants, the Secretary has promulgated the regulations cited above.

The Secretary may, after due notice and opportunity for a hearing, suspend or prohibit from further practice before him any representative who refuses to comply with the Secretary's rules and regulations, or who violates sections 206(a) or 1631(d)(2) of the Social Security Act. The Secretary may recommend to the Office of the Inspector General that criminal charges be brought against representatives who violate the law.

The Secretary may suspend or disqualify a representative if he or she engages in the following conduct:

- in any manner willfully and knowingly deceives, misleads or threatens, either orally or in writing, any claimant or prospective claimant or beneficiary regarding benefits, or other initial or continued rights under the Act;

- knowingly charges or collects, or makes any agreement to charge or collect, directly or indirectly, any fee in excess of that allowed by SSA or a court;

- knowingly makes or participates in the making or presentation of any false statement, representation, or claim about any material fact affecting the rights of any person under the Act; or

- divulges, except as may be authorized by law or the regulations prescribed by the Secretary, any information SSA provides or discloses about the claim or prospective claim of another person.


HALLEX I-1-150

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division I: General Subjects

Subject: Representation of Claimants

Chapter: I-1-100

June 30, 1994

Current through March 1997

I-1-150 PROCESSING AN ALLEGED VIOLATION

Citations: 20 CFR §§ 404.1745 - 404.1795, 410.689 - 410.698, 416.1545 - 416.1595 42 CFR §§ 405.701(c)

A. Initial Referral

Staff in any OHA office may observe or detect suspected violations of the rules pertaining to a representative's conduct. When this occurs, the staff should refer the matter to the Special Counsel Staff (SCS).

1. The referring individual should provide in the referral a description of the basis for suspecting a violation and copies of all available substantiating documentation and evidence.

2. The referring office should proceed with its routine processing of the case and take no further action on the suspected violation unless requested to do so by the SCS.

B. Special Counsel Staff's Action

The Special Counsel Staff processes all referrals regarding possible initiation of suspension or disqualification proceedings.

1. When the Special Counsel Staff receives a referral, it begins an investigation into the matter. The investigation may include interviewing witnesses as well as locating and reviewing documents in the possession of the claimant, witnesses, or federal and state agencies and organizations.

2. If the Special Counsel Staff's investigation indicates that the representative may have acted in violation of the Social Security Act or regulations, the SCS may prepare a warning letter placing the representative on notice of the potential violation and providing a designated time frame within which to comply with statutory and regulatory provisions.

3. If the representative complies with the directions given in the warning letter, the investigation may be closed without further action.

4. If the representative had previously been advised to cease and desist from engaging in proscribed conduct or if it is otherwise inappropriate to attempt informal resolution of the matter, the SCS prepares and serves on the representative a notice and complaint containing a statement of the charges, which initiates sanction proceedings against the representative. The complaint describes with specificity the acts or omissions which constitute the basis for the action, and specifies whether the agency is seeking a disqualification or a suspension for a period of years.

5. The notice advises the representative of his or her right to file within 30 days an answer admitting or denying the factual assertions contained in the complaint, and stating why SSA should not suspend or disqualify him or her from acting as a representative in proceedings before SSA.

6. If the representative's answer provides sufficient showing to support withdrawal of the complaint, SCS will so notify the representative in writing and close the case.

7. If the representative does not file a timely answer or if the answer does not support withdrawal of the complaint, the matter is referred to the Associate Commissioner to designate an Administrative Law Judge (ALJ) to hear and decide the merits of the complaint.

8. If the representative is an attorney, the disciplinary section of the bar association in every State or Territory in which the attorney is admitted to practice is provided notice of our action and a copy of the complaint, answer and supporting evidence to use in whatever action the bar deems necessary.

C. ALJ Actions on a Complaint

The hearing on a complaint seeking the suspension or disqualification of a representative is an adversarial action conducted under the rules and procedures set forth in the regulations. At least 20 days before the hearing, the ALJ must send notice of hearing to both parties setting forth the date, time and location of the hearing. The notice of hearing also usually includes requirements and instructions for filing motions, seeking discovery, requesting witnesses, entering exhibits, and may direct the parties to file a prehearing statement of the parties' contentions and the controlling issues of fact and law.

An attorney from the SCS represents SSA at the hearing. The representative may at his or her option be represented by an attorney or other qualified person.

Either party may request the ALJ to issue subpoenas for witnesses and for the production of records, correspondence, or other documents. The ALJ may also issue subpoenas on his or her own initiative for the same purposes.


These hearings are generally not open to the public. Only the parties and any persons the ALJ or the parties consider necessary may attend.

The ALJ has the right to regulate the conduct of the hearing and to decide the order in which the evidence will be presented. It is the ALJ's responsibility to inquire fully into the matters at issue, hear testimony and argument, and accept into evidence any documentary items that are relevant and material. Witnesses who testify must do so under oath or affirmation.

If, after due notice, one of the parties does not appear at the scheduled hearing, the ALJ should still conduct proceedings so that the party present may offer evidence. The ALJ shall give the absent party an opportunity to show cause for failing to appear and may hold a supplemental hearing if good cause is established. Without a showing of good cause, the party is deemed to have waived the right to be present at the hearing.

If the representative did not file an answer to the charges, he or she may not present evidence at the hearing. The ALJ may make or recommend a decision on the basis of the record, or permit the representative to submit at the oral hearing a statement about the sufficiency of the evidence or the validity of the proceedings.

The ALJ may reopen the hearing to accept additional evidence when the representative did not file an answer but the ALJ believes that material evidence exists which was not presented at the hearing.

At the close of the hearing, the ALJ shall give the parties the opportunity to present oral or written summations, and to file briefs or other statements about proposed findings of fact and conclusions of law.

In all cases, the ALJ must ensure that the oral proceedings are recorded. The ALJ should obtain one original certified transcript for the record, and prepare copies upon request for the parties.

On the basis of the evidence, the ALJ issues a written decision containing findings of fact and conclusions of law.

If the ALJ determines that the charges should be sustained, the ALJ either:

1. Suspends the representative from further practice before SSA for a specified period of not less than 1 year and not more than 5 years from the date of the decision; or

2. Disqualifies the representative from further practice before SSA.

Either party may ask the Appeals Council to review the ALJ's decision. The notice which transmits the decision informs the parties of this right and directs the parties to file the request in writing with the Deputy Chair of the Appeals Council within 30 days from the date the decision was mailed. The ALJ's decision is final and binding unless modified by the Appeals Council upon review.

D. Appeals Council Action

Upon receipt of a request for review, the Appeals Council may: issue a decision which affirms, reverses, or modifies the ALJ's decision; return the case to the ALJ for further proceedings; or dismiss the request for review.

The Appeals Council, in reversing or modifying the ALJ's decision, may not impose a suspension for less than one nor more than five years.

The Appeals Council may dismiss the request for review in any of the following circumstances:

- the party who filed the request for review asks the Appeals Council, in writing, to dismiss the request, and the other party does not object;

- the representative dies; or

- the party requesting review failed to file its request within the 30 day time period and the Appeals Council does not find good cause for extending the filing period.

The Appeals Council issues its final decision or order in writing and mails copies to both parties. The Appeals Council decision is final and binding on all parties; it is not judicially reviewable.

E. Recognizing Representatives Pending Disposition of Charges

A representative against whom charges are pending may continue to represent claimants until a final decision is issued. A decision to suspend or disqualify a representative becomes final and binding unless within 30 days of the date the ALJ mailed the decision, one of the parties requests the Appeals Council to review the decision. When the request for review is filed more than 30 days after the date the ALJ mailed the decision, the decision of the ALJ remains final and binding unless the Appeals Council finds good cause for the untimely filing and assumes jurisdiction. If the Appeals Council reviews the ALJ's decision, the representative may continue to represent claimants until the Appeals Council issues its final decision on the matter. When the Appeals Council issues its decision, any period of suspension or disqualification the Appeals Council imposes is effective from the date of the Appeals Council's decision.


F. Notifying SSA of Representative Suspensions and Disqualifications

Any decision on a complaint following a hearing or Appeals Council review must be promptly transmitted to the Special Counsel Staff by the ALJ who heard the case, or by the Appeals Council after review. When a decision which imposes a period of suspension or a disqualification becomes final and binding, the Special Counsel Staff will initiate notification procedures to ensure that appropriate SSA components are informed of the action. A copy of the ALJ or AC decision will accompany the notification. When the disqualified or suspended representative is an attorney, the disciplinary section of each bar association previously notified of the complaint will be provided a copy of the decision.

G. Attempts by Suspended or Disqualified Representatives to Act as Representatives for Claimants

If a person who has been suspended or disqualified from acting as a representative subsequently attempts to act as a representative for claimants in any matter pending in any SSA office, that office must advise the person in writing that SSA will not recognize him or her as a representative. If the person still insists upon serving as a representative, the SSA office should refuse to recognize him or her and refer the matter by memorandum to the Special Counsel Staff in OHA Headquarters.


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