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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] |
On [insert date], the Appeals Council declined to assume jurisdiction of the Administrative Law Judge's final decision after court remand. The Council has now received your request for more time to file a civil action (ask for court review).
We Are Giving You More Time to File a Civil Action
The Appeals Council now extends the time within which you may file a civil action (ask for court review) for [30] OR [insert number of days] days from the date you receive this letter. We assume that 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.
[Select this paragraph if materials are enclosed]
As you requested, we are enclosing [Identify enclosure(s)].
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]
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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.]