|
SOCIAL SECURITY ADMINISTRATION _____________________________________________________________ | |
|
Refer to: TAHB [SSN] [XSSN] |
Office of Hearings and Appeals 5107 Leesburg Pike Falls Church, VA 22041-3255] | |
Last Update: 9/1/05 (Transmittal II-6-13)
|
|
SOCIAL SECURITY ADMINISTRATION _____________________________________________________________ | |
|
Refer to: TAHB [SSN] [XSSN] |
Office of Hearings and Appeals 5107 Leesburg Pike Falls Church, VA 22041-3255] | |
NOTICE OF APPEALS COUNCIL DECISION
PARTIALLY FAVORABLE
[Representative's First Name, Middle Initial and Last
Name]
[Address]
[City, State
Zip]
Dear [Mr./Ms. [Representative's Last Name]]:
|
Re: |
[Claimant's Name] v. Commissioner of Social Security U.S.D.C. for the [selects District, if appropriate] District of [State] [,] [Division] Civil Action Number [enter number] |
We have made the enclosed decision in this case. Please read this notice and the decision carefully.
This Decision Is Partially Favorable to You
Another office will process the decision and send you a letter about your benefits. Your local Social Security office or another office may first ask you for more information. If you do not hear anything for 60 days, contact your local office.
What This Action Means
This decision is the final decision of the Commissioner of Social Security after remand by the court.
What You Must Do
If you disagree with this decision and want to continue the court action, you must tell us within 10 days.
Our address and FAX number are:
|
ADDRESS: |
Appeals Council |
|
FAX: |
[FAX #], Attn: Branch [#]. |
Put the Social Security Number shown at the top of this letter on your request.
If you send us anything by fax, do not send duplicates by mail. That may delay processing your claim.
What Happens Next
If you tell us you want to continue the court action, we will prepare a certified copy of the administrative record and send it to the U.S. Attorney to file with the court.
If we do not hear from you within 10 days, we will assume that you do not want to continue the court action. We will then send the file to the office that will process the decision.
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:
[Field Office Address]
[City, State ZIP]
|
[Name] | |
|
Administrative Appeals Judge |
Enclosure(s):
cc:
[Claimant's
Name]
[Address]
[City, State
Zip]
[If claimant is unrepresented, letter will be addressed to claimant and “cc” will be deleted.]
[Printed on all copies when the claimant is represented:]
ATTENTION REPRESENTATIVE:
A representative who wants to charge a fee for services performed in a proceeding before the Social Security Administration must submit a fee agreement or file a petition.
IF YOU SUBMITTED A FEE AGREEMENT THAT WAS NOT PREVIOUSLY APPROVED, THE APPEALS COUNCIL'S ACTION ON THE AGREEMENT IS ENCLOSED.
IF YOU DID NOT SUBMIT A FEE AGREEMENT BUT WANT TO CHARGE A FEE FOR YOUR SERVICES, WHEN SERVICES ARE COMPLETED:
Complete the enclosed petition form.
Give your client the CLAIMANT'S COPY and retain the REPRESENTATIVE'S COPY.
Send the remaining copies directly to the
Attorney Fee StaffMark the envelope “Do Not Open in Mailroom.”