Last Update: 9/2/05 (Transmittal I-2-62)
City, State ZIP
I have received additional evidence which I propose to include in the record of your case. (See enclosed LIST OF ADDITIONAL EVIDENCE.) I am sending this evidence to the Social Security office shown below. They will notify you when the evidence is available for your examination, and give you 10 days to come to the office to examine it. If you cannot come to the office within 10 days to examine the evidence, you must call the Social Security office shown below and request additional time. The Social Security Office will communicate with the undersigned as to your request and you will be informed of my response. Because your case is now within my jurisdiction, personnel in the Social Security office will not be permitted to discuss the evidence with you or to provide you with copies of it.
You may submit any or all of the following: written comments concerning the enclosed evidence, a written statement as to the facts and law you believe applies to your case in light of the evidence, and submit any additional records you wish for me to consider. You may also submit written questions to be sent to the author(s) of the enclosed evidence. You may also request a supplemental hearing with respect to this evidence and if required for a full and true disclosure of the facts in your case, you may request to orally question the author(s) of this (these) report(s).
You may request that the Administrative Law Judge (ALJ) issue a subpoena to require the attendance of witnesses or the submission of records. You must submit a subpoena request to the ALJ, in writing, no later than 5 days before the date of any supplemental hearing. Any request must provide the names of the witnesses or documents to be provided; the address or location of the witnesses or documents with sufficient detail to find them; a statement of the important facts that the witness or document is expected to prove; and the reason why these facts cannot be proven without the issuance of a subpoena. The ALJ will issue a subpoena only if necessary for the full presentation of your case.
The Social Security office will tell me if they do not hear from you within 10 days of the date of their notice. I will then assume that you do not wish to examine or comment on the evidence or request a supplemental hearing, and that you have no further documentation to submit. I will carefully consider your case and issue a decision on the evidence of record.
Administrative Law Judge
(list the additional evidence)
cc: Social Security Office