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II-6-4-10. REV 10 Grant Review Notice — Propose to Issue AC Decision (All Titles)

	SOCIAL SECURITY ADMINISTRATION _____________________________________________________________
	Refer to: TAHB [SSN] [XSSN]	Office of Hearings and Appeals 5107 Leesburg Pike Falls Church, VA 22041-3255 Telephone: 703-605-8000 Date: [Month, Day, Year]

NOTICE OF APPEALS COUNCIL ACTION

[Claimant's First Name, Middle Initial and Last Name]

[Address]

[City, State Zip]

This is about your request for review of the Administrative Law Judge's [decision] OR [dismissal] OR [decision and dismissal] dated [insert date]. [If good cause for untimely filing is found insert SP 1 RV]

[If taking separate action on another title insert SP 2 RV.]

We Have Granted Your Request for Review

The Appeals Council is reviewing the Administrative Law Judge's [decision] OR [dismissal] OR [decision and dismissal].

Rules We Applied

Under our rules, we will review your case for any of the following reasons.

• The Administrative Law Judge appears to have abused his or her discretion.

• There is an error of law.

• The decision is not supported by substantial evidence.

• There is a broad policy or procedural issue that may affect the public interest.

• We receive new and material evidence and the decision is contrary to the weight of all the evidence now in the record.

In your case, we found that [there is an error of law] AND/OR [the decision is not supported by substantial evidence] AND/OR there is new and material evidence and the decision is contrary to the weight of all the evidence now in the record].

What We Considered

We considered the written record that was before the Administrative Law Judge [and the testimony at the hearing].

[If proffering additional evidence, insert]:

We are enclosing a copy of more evidence that we are adding to the record of your case. [We are also sending a copy to your representative.]

What We Plan To Do

We plan to make a decision finding [State the proposed conclusion of the AC's decision.]

Why We Are Taking This Action

[Enter the rationale for the AC conclusion(s), including a discussion of why the AC disagrees with the hearing decision.]

You May Send More Information

You may send us more evidence or a statement about the facts and the law in your case within 30 days of the date of this letter.

[If closed record applies, insert:]

We will consider more evidence if:

• It is new and material;

  AND

• It is about “disability” starting on or before [insert date], the date of the hearing decision.]

[If DLI expires before hearing decision (Title II disability only) insert:

We will consider more evidence if:

• It is new and material;

  AND

• It is about “disability” starting on or before [insert DLI], the date you were last insured for disability benefits.]

[If DLI expires before hearing decision (concurrent disability claims) insert]:

We will consider more evidence about your claim for Social Security if:

• It is new and material;

  AND

• It is about “disability” starting on or before [insert DLI], the date you were last insured for disability benefits.

We will consider more evidence about your claim for Supplemental Security Income if:

• It is new and material;

  AND

• It is about “disability” starting on or before [insert date], the date of the hearing decision.]

[If other disability or non-disability issue(s), insert:]

We will consider more evidence if:

• It is new and material;

  AND

• It is about [Enter issue(s) to be decided by the AC].

You May Ask For An Appearance

You may ask for an appearance before the Appeals Council to tell us about your case. You must tell us in writing within 30 days from the date of this letter why you want an appearance.

Under our rules, we will give you an appearance if:

• There is an important question of law or policy;

  OR

• Oral argument would help us reach a proper decision.

If we decide to give you an appearance, we will notify you about the time and place at least 10 days before the date scheduled for your appearance.

[If proffering non-procedural evidence, include]:

You May Ask for a Hearing

You may also ask for a hearing before an Administrative Law Judge. You must tell us in writing within 30 days from the date of this letter if you want a hearing.

We Will Not Act For 30 Days

If you have more information, you must send it to us within 30 days of the date of this letter.

Our address and FAX number are:

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 30 days, we will assume that you do not want to send us more information or appear before the Appeals Council. We will then make our decision.

[If option for ALJ hearing used above, replace above sentence with:]

If we do not hear from you within 30 days, we will assume that you do not want to send us more information, appear before the Appeals Council or have a hearing before an Administrative Law Judge. 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.

Enclosure[s]:
[List additional evidence being proffered]
Self-addressed envelope


[If there is a representative, insert:]
cc:
[Representative's Name]
[Address]
[City, State Zip]

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