Last Update: 9/1/05 (Transmittal II-6-13)
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SOCIAL SECURITY ADMINISTRATION _____________________________________________________________ | |
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Refer to: TAHB [SSN] [XSSN] |
Office of Hearings and Appeals 5107 Leesburg Pike Falls Church, VA 22041-3255 Telephone: 703-605-8000 Date: [Month, Day, Year] | |
NOTICE OF APPEALS COUNCIL ACTION
[Claimant's First Name, Middle Initial and Last
Name]
[Address]
[City,
State Zip]
This is about your request for review of the Administrative Law Judge's dismissal dated [insert date]. [If good cause for untimely filing is found insert SP 1]
[If taking separate action on another title
insert SP 5]
[If vacating prior AC
action, insert SP 2]
We Have [Again] Denied Your Request for Review
[After considering the additional information,] [w/We] found no reason under our rules to review the Administrative Law Judge's dismissal. Therefore, we have denied your request for review.
Rules We Applied
[Delete this sentence if RSI case: We applied the laws, regulations and rulings in effect as of the date we took this action.]
Under our rules, we will review your case for any of the following reasons.
The Administrative Law Judge appears to have abused his or her discretion.
There is an error of law.
The decision is not supported by substantial evidence.
There is a broad policy or procedural issue that may affect the public interest.
We receive new and material evidence and the decision is contrary to the weight of all the evidence now in the record.
What We Considered
In looking at your case, we considered the reasons you disagree with the dismissal] OR [additional evidence] OR [reasons you disagree with the dismissal and the additional evidence].
We found that this information does not provide a basis for vacating the Administrative Law Judge's dismissal.
[As required, discuss additional evidence and/or contentions, including allegations of bias, misconduct or unfair hearing]
[If referring evidence/material to another component, insert SP 8]
[If returning new applications to an SSA field office, insert SP 7]
If You Have Any Questions
If you have any questions, you may call, write, or visit any Social Security office. If you do call or visit an office, please have this notice with you. The telephone number of the local office that serves your area is [Insert area code and number of servicing Field Office]. Its address is:
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[Field Office Address |
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[Name] Administrative Appeals Judge |
[If there is a representative,
insert:
cc:
Representative's
Name
Address
City, State Zip]