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 decision 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 SP2]
We Have [Again] Denied Your Request for Review
[After considering the additional information, w/]We found no reason under our rules to review either the dismissal action or the decision of the Administrative Law Judge. Therefore, we have denied your request for review.
This means that the Administrative Law Judge's decision is the final decision of the Commissioner of Social Security in your case about [Enter claim type(s) and/or period ruled on by the ALJ].
The Administrative Law Judge dismissed part of your request for hearing regarding whether you were disabled on or before [enter period previously ruled on].
Therefore, our earlier [determination(s)] OR [decision(s)] OR [determination(s) and decision(s) dated [insert date(s)] about that period stand[s] as the final decision of the Commissioner of Social Security.
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 Administrative Law Judge's action] OR [additional evidence] OR [reasons you disagree with the Administrative Law Judge's action and the additional evidence] AND [listed on the enclosed Order of the Appeals Council] OR [in the material listed on the enclosed Order of the Appeals Council].
We found that this information does not provide a basis for changing the Administrative Law Judge's decision or dismissal.
[As required, discuss additional evidence and/or contentions, including allegations of bias, misconduct or unfair hearing. Use SPs 3 or 4 as appropriate]
If You Disagree With Our Action
If you disagree with our action, you may ask for court review only of the Administrative Law Judge's decision concerning [enter claim type(s) and/or period currently ruled on] by filing a civil action.
If you do not ask for court review, the Administrative Law Judge's decision will be a final decision that can be changed only under special rules.
You Are Not Entitled to Court Review of the Administrative Law Judge's Dismissal
Under our rules, you are not entitled to court review of the Administrative Law Judge's action dismissing part of your request for hearing regarding whether you were disabled on or before [enter period previously ruled on].
Our earlier [determination(s)] OR [decision(s)] OR [determination(s) and decision(s)] dated [insert date(s)] about that period [is] OR [are] final and not subject to further review.
[If foreign claim, replace court rights paragraphs with SP 6]
How To File A Civil Action
You may file a civil action (ask for court review) by filing a complaint in the United States District Court for the judicial district in which you live. The complaint should name the Commissioner of Social Security as the defendant and should include the Social Security number(s) shown at the top of this letter.
You or your representative must deliver copies of your complaint and of the summons issued by the court to the U.S. Attorney for the judicial district where you file your complaint, as provided in rule 4(i) of the Federal Rules of Civil Procedure.
You or your representative must also send copies of the complaint and summons, by certified or registered mail, to:
The General Counsel
Social Security Administration
Room 617 Altmeyer Building
6401 Security Boulevard
Baltimore, MD 21235And:
The Attorney General of the United States
Washington, DC 20530
Time To File A Civil Action
You have 60 days to file a civil action (ask for court review).
The 60 days start the day after you receive this letter. We assume you received this letter 5 days after the date on it unless you show us that you did not receive it within the 5-day period.
If you cannot file for court review within 60 days, you may ask the Appeals Council to extend your time to file. You must have a good reason for waiting more than 60 days to ask for court review. You must make the request in writing and give your reason(s) in the request.
You must mail your request for more time to the Appeals Council at the address shown at the top of this notice. Please put the Social Security number(s) also shown at the top of this notice on your request. We will send you a letter telling you whether your request for more time has been granted.
About the Law
The right to court review for claims under title II (Social Security) is provided for in Section 205(g) of the Social Security Act. This section is also Section 405(g) of Title 42 of the United States Code.
The right to court review for claims under title XVI (Supplemental Security Income) is provided for in Section 1631(c)(3) of the Social Security Act. This section is also Section 1383(c) of Title 42 of the United States Code.
The rules on filing civil actions are Rules 4(c) and (i) in the Federal Rules of Civil Procedure.
[If there is a request for reopening, insert SPs
9, 9a or 9b]
[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] | |
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[Administrative Appeals Judge] | |
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OR | |
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[Appeals Officer] |
[If AC order enclosed,
insert:
Enclosure:
Order of the Appeals
Council]
[If there is a representative,
insert:
cc:
[Representative's
Name
[Address]
[City, State
Zip]