Signature of Claimant Form SSA-1560-U4 03-2014 EF 03-2014 Destroy Prior Editions FILE COPY INSTRUCTIONS FOR USING THIS PETITION Any attorney or other representative who wants to charge or collect a fee for services rendered in connection with a claim before the Social Security Administration SSA is required by law to first obtain SSA s approval of the fee sections 206 a and 1631 d 2 of the Social Security Act 42 U.S.C. Where to File the Petition copy of each attachment. The representative may then file the original and third carbon copy the OHA Copy of the SSA-1560-U4 and the attachment s with the appropriate SSA office If a court or the Appeals Council issued the decision send the petition to the Office of Hearings and Appeals. Form Approved OMB No* 0960-0104 TOE 850 SOCIAL SECURITY ADMINISTRATION IMPORTANT INFORMATION ON REVERSE SIDE PETITION TO OBTAIN APPROVAL OF A FEE FOR REPRESENTING A CLAIMANT BEFORE THE SOCIAL SECURITY ADMINISTRATION Fee I request approval to charge a fee of Sho....
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How to fill out the SSA-1560-U4 online
Filing the SSA-1560-U4 form online is an essential step for appointed representatives looking to request approval for fees related to services rendered before the Social Security Administration (SSA). This guide will provide detailed, step-by-step instructions on how to effectively complete this form, ensuring all necessary information is accurately recorded.
Follow the steps to complete the SSA-1560-U4 online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin filling out the 'Representative’s Information' section. Enter the representative's Rep ID, first name, middle initial, last name, and business address, including city, state, zip/postal code, and telephone number.
- Next, complete the 'Claimant's Information' section. Enter the claimant's first and last names and their Social Security number.
- In the 'Fee Amount Requested' section, specify the fee being requested, as well as the dates services began and ended.
- Indicate the type of claims (select from Title II Disability, Retirement, Title XVI Disability, Other Title XVI or VIII, CDR, or Post Entitlement) that the petition pertains to.
- Itemize the services provided by listing each meeting and correspondence, as well as other activities. Attach the detailed list including all necessary information.
- Answer the questions regarding any past payments received towards the fee, whether you hold any money in a trust or escrow account, and if a fee agreement exists.
- Review any additional questions concerning reimbursements for expenses, services provided before a court, and any disciplinary actions or disqualifications.
- Declare under penalty of perjury that all information provided is true and correct by signing the form.
- Finally, save the changes, download, print, or share the completed form as needed and ensure it is submitted to the appropriate SSA office.
Complete your SSA-1560-U4 form online today and ensure your fee request is submitted accurately.
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