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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], we received [exceptions] OR [a request for more time in which to file exceptions] explaining the reasons you disagree with the Administrative Law Judge's decision date [insert date].
Under our rules, you must send us exceptions or ask for more time to do so within 30 days of the date you receive the Administrative Law Judge's decision.
Based on the date of the Administrative Law Judge's decision, it does not appear that you acted timely.
What You Must Do
You must show that you sent us [exceptions] OR [a request for more time in which to file exceptions] within 30 days of the date of you received the Administrative Law Judge's decision.
You must send us [proof that you sent us exceptions on time.] OR [proof that you asked for more time within the time limit. You must also send any written exceptions to the Administrative Law Judge's decision.]
We Will Not Act For 20 Days
You must send us the above information within 20 days from the date of 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.
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 20 days, we will send you a letter telling you about your further rights to appeal this case.
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.]