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Social Security Appeal

Fee Agreement



Fee Amount


     I agree that if the Social Security Administration (SSA) favorably decides my claim or claims, I will pay and my Social Security Representative Roger N. Meyer shall be entitled to charge a fee equal to the lesser of 25% of the past due benefits resulting from my claim or claims or $5,300.00, the amount established by Social Security Administration Notice of January 8, 2002, as found in the US Federal Register of January 17, 2002 (Volume 67, Number 12)][Notices] [Page 2477].


Costs and Expenses


     Apart from and separate from the foregoing agreement to pay fees, I also agree to pay, as billed, to my Social Security Representative Roger N. Meyer the costs or expenses incurred by him, sometimes known as "out of pocket costs," the cost of depositions, briefings, medical reports or examinations, vocational analyses, evaluations and reports, examinations or conference with my doctors, filing fee, court costs, postage, telephone and reproduction costs, reasonable travel costs and travel and mileage costs at no less than 50 cents per mile for automobile travel.  I also agree to pay Roger N. Meyer costs related to the appearance and/or testimony of doctors or other expert witnesses, and any and all other out of pocket expenses or costs associated with the promotion of my claims for Social Security benefits.  I understand that such costs are not subject to approval of any agency or court and are payable and due from me as billed by my Social Security Representative.



            Signature of Social Security claimant



Signature of claimant's representative payee or person authorized by claimant to conduct claimant's financial affairs and/or act as fiduciary.





                        ROGER N. MEYER






OADM Fee Agreement 7-2003

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