disagree with the amount of the fee requested or any information given, and to ask more questions about the information given in this request (as explained on the reverse side of this form). I have marked my choice below. I agree with the $ fee which my representative is asking to charge and collect. By signing this request, I am not giving up my right to disagree later with the total fee amount the Social Security Administration authorizes my representative to charge and collect. OR I do not a.
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How to fill out the SSA-1560-U4 online
The SSA-1560-U4 form is a petition to obtain approval for charging a fee for services rendered as a representative before the Social Security Administration. This guide provides clear, step-by-step instructions to assist users in completing the form online efficiently.
Follow the steps to complete the SSA-1560-U4 online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter the fee amount you request to charge for your services. This should be a clear dollar amount.
- Indicate the time frame for your services by entering the start and end dates in the provided fields (month, day, year).
- Specify the type of claims you are representing by entering the claim name and the associated Social Security number.
- Itemize your services rendered before the SSA on a separate page. Include dates, descriptions, actual time spent, and total hours.
- Answer whether you have entered into a fee agreement with your client. If yes, specify the agreed amount and attach a copy of the agreement.
- Indicate if you have received payments toward your fee from any source other than SSA funds. If yes, specify the sources and amounts.
- State whether you expect reimbursement for any expenses incurred and itemize those expenses if applicable.
- Confirm if any services were rendered in connection with State or Federal court matters and report the related fees if applicable.
- Answer the questions regarding disbarment and disqualification from Federal programs, providing necessary details.
- Sign and date the form as the representative. Ensure to provide your association's firm name, address, and contact number.
- The claimant also has the option to sign, indicating their agreement or disagreement with the requested fee.
- Once all sections are complete, review the form, then save your changes, download, print, or share the completed form as needed.
Complete your SSA-1560-U4 form online today for seamless submission and approval.
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