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SSDI & DISABILITY SERVICES
Non-Representative Client Services Agreement
Get organized, prepared, and supported as you navigate your SSDI or SSI application.
IMPORTANT NON-REPRESENTATION NOTICE: Consultant is not the Client's attorney, SSA-appointed representative, medical provider, or government agent. Consultant provides education, organization, and administrative support only. Client remains responsible for all decisions, statements, signatures, submissions, deadlines, and communications with SSA
Parties and Agreement
This Client Services Agreement (Agreement) is entered into between Dahlia Veritas Consulting LLC, a Georgia limited liability company (Consultant), and the client identified above (Client). The Agreement includes Exhibit A, which records the selected services, fees, payment schedule, and service period.
Purpose and Nature of the Relationship
Consultant will provide non-representative educational and administrative support relating to a Clientled application for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). Consultant does not act for Client before the Social Security Administration (SSA), does not enter an appearance, and is not authorized to bind Client. No attorney-client, representative-client, fiduciary, medical-provider, or government relationship is created. Consultant does not hold itself out as endorsed, employed, certified, or approved by SSA or any other government agency.
Services Included
Subject to the package selected in Exhibit A, Consultant may provide:
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General education about the publicly available SSDI and SSI application process.
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A personalized application-readiness and document checklist.
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Administrative organization of information supplied by Client, including treatment providers, medications, work history, and important dates.
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Worksheets that help Client describe symptoms, daily activities, job duties, and functional limitations in Client's own words.
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Guided sessions while Client completes SSA forms or online fields.
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A completeness and consistency review that identifies blanks, date conflicts, duplicate entries, and information Client may wish to verify.
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A submission-readiness checklist and a deadline tracker maintained from information Client provides.
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Post-submission administrative check-ins within the selected service period.
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Referrals to attorneys, SSA-registered representatives, medical providers, vocational professionals, or community resources when appropriate.
Services Not Included
Consultant will not:
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Provide legal advice, interpret law for Client, select legal arguments, or give an opinion about Client's legal rights.
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Provide medical advice, diagnose a condition, recommend treatment, or create or alter medical evidence.
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Act as Client's representative, complete an SSA appointment of representative, or communicate with SSA as Client's advocate.
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Sign, attest to, certify, or submit an application, appeal, authorization, or other statement on Client's behalf.
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Access Client's my Social Security account, request Client's password or authentication code, or impersonate Client.
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Receive official notices or records from SSA as Client's representative.
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Attend or advocate at an SSA interview, conference, or administrative hearing as Client's representative.
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Promise eligibility, approval, a particular onset date, back pay, processing time, or benefit amount.
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Provide services for VA disability claims, workers' compensation, private disability insurance, or court proceedings unless covered by a separate written agreement that is legally permitted.
Client Control, Review, and Submission
Client retains complete control over the application. Client will personally review all information for truth, accuracy, and completeness; decide what information to provide; sign or electronically attest to each form; submit materials directly to SSA; communicate with SSA; and retain copies and confirmation receipts.
Consultant may sit with Client or provide remote guidance while Client enters information. Any draft, worksheet, checklist, or organized summary is for Client's review and use. Client must make any corrections and independently approve the final submission.
Fees, Expenses, and Payment
The initial consultation fee is $200 and is earned when the scheduled consultation is delivered. Exhibit A states whether that fee is credited toward another selected package. Additional services are charged at the flat fees or hourly rates stated in Exhibit A. Payment is due according to the schedule in Exhibit A.
Fees are charged for non-representative education and administrative support. They are not contingent on approval, are not calculated as a percentage of past-due or future benefits, and are not representative fees submitted to SSA for authorization.
Consultant will not incur third-party expenses without Client's written approval. Approved expenses, such as copying, postage, or provider record charges, will be billed at actual cost without markup. Consultant may pause future work for an overdue balance after giving written notice, but Client remains responsible for all SSA deadlines.
Cancellation, Refunds, and Scheduling
Client may cancel this Agreement at any time by written notice. Consultant may terminate for nonpayment, abusive conduct, failure to provide accurate information, a conflict of interest, a request for prohibited services, or circumstances requiring a licensed or registered professional. Consultant will provide reasonable notice when practical.
The consultation fee is nonrefundable after the consultation occurs. Other prepaid fees are earned as the milestones in Exhibit A are completed. The Consultant will refund any unearned prepaid balance within 14 calendar days after the final accounting. Missed-session and rescheduling terms are stated in Exhibit A. Termination does not extend an SSA deadline.
Client Responsibilities
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Provide truthful, complete, and timely information and promptly correct known errors.
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Personally monitor mail, email, voicemail, online notices, and all SSA deadlines.
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Promptly send Consultant copies of relevant notices if Client wants administrative tracking support.
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Review, sign, and submit all forms and retain proof of submission.
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Never share passwords, multifactor authentication codes, or account recovery information with Consultant.
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Attend SSA and medical appointments and respond directly to government requests.
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Seek legal, medical, tax, or benefits advice from qualified professionals when needed.
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Notify Consultant of changes in contact information, work, income, health, representation, or claim status that affect the selected support services.
Information Handling and Confidentiality
Client authorizes Consultant to receive and organize documents Client voluntarily provides for the limited purpose of performing this Agreement. Consultant will use reasonable administrative and technical safeguards and will limit access to personnel or contractors who need the information to perform authorized services and who are subject to confidentiality obligations.
Consultant is not a health-care provider and does not represent that it is a HIPAA-covered entity. Client should use Consultant's designated secure delivery method and should not send Social Security numbers, medical records, or other sensitive information by ordinary text message or unencrypted email. No electronic method can be guaranteed completely secure.
Consultant may disclose information with Client's written authorization, to service providers supporting Consultant's operations, or when required by law. Working materials will ordinarily be deleted or securely destroyed within 90 days after services end, except for contracts, payment records, required business records, or materials subject to a legal hold. Client is responsible for keeping complete copies of all claim materials.
No Guarantee and Reliance on Client Information
SSA alone decides eligibility and benefit amounts. Consultant does not guarantee any outcome or processing time. Consultant may rely on information supplied by Client and is not responsible for independently verifying medical, employment, financial, or other facts. Client remains responsible for the truth and accuracy of all information submitted to SSA.
Referral and Escalation
Consultant may recommend that Client obtain an attorney or SSA-registered representative, particularly for a denial, reconsideration, administrative hearing, missed deadline, cessation, overpayment, fraud allegation, conflicting prior application, work-activity issue, or any matter requiring legal judgment or advocacy. Consultant may stop work that would cross the non-representation boundary. Client may accept or decline a referral and may choose any professional.
Communication and Accessibility
Routine communications will occur through [secure portal/email/telephone]. Consultant generally responds within [two] business days. Consultant will make reasonable efforts to provide accessible communication upon request. Email and text are not appropriate for urgent or emergency matters. Consultant does not provide crisis, emergency, or medical services.
Intellectual Property and Client Records
Client owns Client's personal records and completed submissions. Consultant retains ownership of its original checklists, educational materials, workflows, and templates. Consultant grants Client a limited, nontransferable license to use those materials for Client's personal claim. Client may not sell or distribute Consultant's proprietary materials.
Limitation of Liability
To the fullest extent permitted by applicable law, Consultant will not be liable for indirect, incidental, special, or consequential damages, lost benefits, or losses caused by SSA action, Client delay, missed deadlines not disclosed to Consultant, inaccurate Client information, provider delay, mail or technology failure, or Client's failure to review and submit materials. Consultant's aggregate liability arising from this Agreement will not exceed the fees Client paid under this Agreement. This paragraph does not limit liability that cannot legally be limited, including liability for willful misconduct or gross negligence.
General Terms
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Entire agreement. This Agreement and its exhibits contain the entire agreement concerning these services and replace prior discussions or proposals.
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Changes. A change must be in writing and signed by both parties.
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Severability. If one provision is unenforceable, the remaining provisions will continue to the extent permitted by law.
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No waiver. A delay in enforcing a provision is not a waiver of that provision.
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Assignment. Neither party may transfer this Agreement without the other's written consent, except that Consultant may use qualified contractors for administrative tasks subject to confidentiality requirements.
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Electronic signatures. Signatures delivered electronically or in counterparts will be treated as originals to the extent permitted by law.
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Headings. Headings are for convenience and do not change the meaning of the provisions.
Client Acknowledgments
By signing, Client acknowledges and agrees that:
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Consultant is not Client's attorney or SSA-appointed representative.
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Consultant will not sign, attest to, or submit a claim or appeal for Client.
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Client must communicate with SSA and personally monitor all deadlines.
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Consultant provides administrative support and general education, not legal or medical advice.
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Fees are flat or hourly service fees and are not contingent on benefits or calculated from past-due benefits.
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Client has read the Agreement, had an opportunity to ask questions, and may obtain independent legal advice before signing.
Exhibit A - Selected Services and Fees
This Exhibit is part of the Agreement. Complete all blanks before signing.
Initial
Consultation
200$
One 60 minutes Consultation
Additional
Support
/HR
Only with Client's written approval
Guided SSDI/SSI application support
Records Organization
Reconsideration Administrative Support
Administrative support only; no advocacy
PAYMENT TERMS
SERVICE PERIOD AND COMMUNICATION
Rescheduling policy: At least [24] hours' notice is requested. A missed session or late cancellation may be treated as delivered, except in an emergency or for reasonable accommodation.
Business Contact Information
Dahlia Veritas Consulting LLC
8735 Dunwoody Place Ste N
Atlanta, GA 30350
dahliaveritasconsulting@gmail.com
404-527-9194
www.dahliaveritasconsulting.com