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Model Fee Agreement Language |
Fee for ServicesMy representative and I understand that, for a fee to be payable, the Social Security Administration (SSA) must approve any fee my representative charges or collects from me for services my representative provides in proceedings before SSA in connection with my claim(s) for benefits. We agree that, if SSA favorably decides the claim(s), I will pay my representative a fee equal to the lesser of [Insert a percent of past-due benefits (a number less than or equal to 25)] or [Insert a dollar amount (a number less than or equal to $5,300)]. Review of the FeeWe understand that one or both of us may request review of the fee amount, in writing, within 15 days after SSA has notified us of any amount my representative can charge.
If someone requests review, SSA generally would send the other(s) a copy and offer an opportunity to comment on the request and provide more information to the person reviewing the request. SSA then would finally decide the amount of the fee and notify us in writing whether the fee increased, decreased, or did not change. We both have received signed copies of this agreement. |
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Last reviewed or modified Monday Jan 14, 2008 |