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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] | |
NOTICE OF ORDER OF APPEALS COUNCIL
DISMISSING REQUEST FOR
REVIEW
[Claimant's First Name, Middle Initial and Last Name]
[Address]
[City, State Zip]
What This Order Means
We have dismissed your request for review. In the enclosed order, we explain why we did this.
If You Disagree With Our Action
If you disagree with our action, you may ask for court review of our dismissal of your request for review by filing a civil action.
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 of our dismissal of your request for review is provided for in Acquiescence Ruling 99-4(11), Bloodsworth v. Heckler, 703 F.2d 1233 (11th Cir. 1983). That ruling states that notices sent by the Appeals Council which dismiss requests for review of Administrative Law Judge decisions will advise claimants of their right to request judicial review, if they live in Alabama, Florida or Georgia at the time of the Appeals Council dismissal.
The rules on filing civil actions are Rules 4(c) and (i) in the Federal Rules of Civil Procedure.
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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Administrative Appeals Judge |
cc:
[If there is a representative, insert:]
[Representative's Name]
[Address]
[City, State Zip]