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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] | |
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] | |
[Representative's First Name, Middle Initial and Last
Name]
[Address]
[City, State
Zip]
Dear [Mr./Ms. [Representative's Last Name]]:
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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] |
The Appeals Council grants your request for more time to send us written exceptions explaining the reasons you disagree with the Administrative Law Judge's decision dated [insert date].
The Appeals Council acknowledges receipt of your request for an appeal of the Administrative Law Judge's decision dated [insert date]. Your letter states that you disagree with the decision, but does not include any written exceptions.
[Use following paragraph, if exhibits, recording(s), etc., are being sent.]
[Enclosed are the] [copies of the exhibits] [and] [duplicate recording(s)] [you asked for]. We are [also] enclosing [Insert language specifying enclosure].
We Will Not Act For [insert number] Days
If you have exceptions, you must send them to us within [insert number] days of the date of this letter. We will not allow more time to send exceptions except for very good reasons.
Our address and FAX number are:
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ADDRESS: |
Appeals Council |
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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 we do not hear from you within [insert number] days, we will assume that you do not want to send us exceptions. We will then make our decision.
If You Have Any Questions
If you have any questions, you may call or write the Appeals Council. Our telephone number and address are shown at the top of this letter. If you do call, please have this notice with you.
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[Name] | |
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Hearings and Appeals Analyst |
Enclosure:
Self-addressed envelope
cc:
[Claimant's
Name]
[Address]
[City, State
Zip]
[If claimant is unrepresented, letter will be addressed to claimant and “cc” will be deleted.]