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 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] AND/OR [these is a broad policy or procedural issue that may effect the public interest].
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 set aside the favorable hearing decision and send your case back to an Administrative Law Judge for more action and a new decision.
Why We Are Taking This Action
The notice attached to the Administrative Law Judge's decision told you that if you asked the Appeals Council to review your decision, the Council would consider all of the decision, even the parts with which you agree. The notice also told you that requesting review places the entire record of your case before the Council. Review can make any part of the Administrative Law Judge's decision more or less favorable or unfavorable to you.
[Enter discussion of what the ALJ found, why the AC disagrees and what further proceedings the AC will direct on remand.]
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 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.
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:
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ADDRESS: |
Appeals Council Office of Hearings and Appeals ATTN: Branch [#], Suite [#] 5107 Leesburg Pike Falls Church, VA 22041-3255 |
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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 30 days, we will assume that you do not want to send us more information or appear before the Appeals Council. We will then send your case back to an Administrative Law Judge.
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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Administrative Appeals Judge |
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[Name] |
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Administrative Appeals Judge |
Enclosure[s]:
[List additional
evidence being proffered]
Self-addressed
envelope
[If there is a
representative, insert:]
cc:
[Representative's
Name]
[Address]
[City, State
Zip]