Representative Fee Structures

The information in this segment should be used in conjunction with the fee structure information provided in Lesson Six of the on-line Business Guide.  In this segment, we'll provide a sample fee petition and contract document used in disability representation.  Please note that although we describe three different types of payment options, all three can and should be included in a single contract.  You and the client can then choose the payment option that best fits the case.  Social Security has recently created a new website specifically discussing the representative fee structure.  This Social Security site contains step-by-step instructions.  Visit this site at www.ssa.gov/representation. 

Protecting Your Fee:

With the advent of our new Advocate Client Manager software, protecting your fee has just gotten easier.  The ACM is the only software that allows you to automatically produce a fee petition attachment assuring that all of your work is documented.  The fee petition attachment is your record of work performed for the client and is required by Social Security.  To review our other unique fee protection techniques, visit the Protecting Fees segment of the Executive Website.

Completing form 1696:

In order to collect a fee, you must first become the client's authorized representative.  The first step in accomplishing this is the filling out and signing of SSA Form-1696, Appointment of Representative request form.

The ( following page) contains a sample form 1696-U2 representational authorization form.   An original of this form can be obtained from your local Social Security district office if your desire.  When you get a copy of the original, make multiple copies for your day-to-day operations. The 1696-U2 is a Social Security form which when signed by you and the claimant, gives you the legal right to act as the claimant's authorized representative before the Social Security administration.

Section II of the SSA-1696 is completed by the representative.  Section one of the form must be signed by the claimant.  Once the 1696 is completed and signed by both the claimant and the representative, it is then submitted to Social Security to become a part of the claimant's folder.  Social Security will stamp the form making it an official adjudicative document.  Unless you're working at no charge, ignore Section three of this form.   Click to see sample fee petition below:

Client Instruction Sheet:

This instruction sheet contains sample language used to direct a client in filling out materials found in your information packet.  An information packet is sent out to clients who are considering representation.  An information packet should also contain a copy of your fee contract or fee petition along with materials describing your service.

Client Instruction Sheet:

If you are thinking of applying or are in the process of applying for the first time, please notify us before taking any further actions with Social Security.  We may be able to structure and present your case in such a way on the initial application, that would result in your receiving benefits without using the appeal process. A properly presented case on the initial application can save you an enormous amount of time.  If you would like early assistance with your case, then complete the materials within this information packet.

If you have applied for disability benefits and have received a denial within the last sixty to ninety days, please follow the instructions below.  If you are not ready to use our service, please place these papers in a safe place until you receive your first denial decision from Social Security  If you would like representation now, please complete and sign the1696 and return it to us as soon as possible.
 

INSTRUCTION

1. Please complete and sign the 1696 form.

2.  Sign both the fee petition and fee contract forms.

3. Send a check or money order in the amount of $__________.   This is a development fee used to pay for the acquisition of medical records and other forms of documentation in your case.  Please return these materials in the envelope provided and mail them to the address below. (Using business reply envelopes makes this step easier for the client).

4. When we receive your paperwork, you'll be notified by our office.  If you have no phone, please provide the phone number of a friend or relative who we can contact if needed.   (Place your name or company name, address and phone number here).