Representative Fee Review Checklist worksheet
Use this checklist to organize fee agreement, back pay, costs, SSA approval, and payment records.
| Item | Your notes |
|---|---|
| Use This Checklist To Organize Fee Agreement | ____________________________ |
| Back Pay | ____________________________ |
| Costs | ____________________________ |
| Ssa Approval | ____________________________ |
| Payment Records | ____________________________ |
| Representative name | ____________________________ |
| Appointment form | ____________________________ |
| Fee agreement date | ____________________________ |
| Fee method | ____________________________ |
| Past-due benefit issue | ____________________________ |
| Out-of-pocket expenses | ____________________________ |
| SSA fee notice | ____________________________ |
Before you use this checklist
- Copy dates and instructions from the current SSA notice rather than memory.
- Keep originals and work from copies.
- Do not send Social Security numbers, bank information, or full medical files to an unverified recipient.
- Save filing confirmations and proof of any time-sensitive submission.