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]
This is also about the favorable determination dated [insert date] on your later claim(s).
[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 [there is a broad policy or procedural issue that may affect the public interest].
We Are Reopening the Favorable Determination
We looked at your case to see if the favorable determination was correct. After considering all of the information, we plan to combine the two cases and issue a new decision.
[If separate actions are being taken, insert:]
This letter is only about reopening your favorable claim[s] for Social Security benefits. We are not changing the favorable determination about your claim for Supplemental Security Income benefits.
Rules We Applied
Under our rules, we may reopen (look again at) and change a determination within the following time limits.
Within 12 months of the date of the notice of the initial determination for any reason.
Within 2 years of the date of the notice of the initial determination in a Supplemental Security Income claim if there is “good cause.”
Within 4 years of the date of the notice of the initial determination in a Social Security claim if there is “good cause.”
We will find there is “good cause” to take another look at the determination in your case for any of the following reasons.
New and material evidence.
A clerical error.
The evidence considered in making the determination clearly shows that there was an error.
In your case, the notice[s] of the initial determination[s] [is/are] dated [insert date].
What We Considered
We considered the written record that was before the Administrative Law Judge [and the testimony at the hearing] and the record considered with the favorable determination.
[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 hearing decision, combine the claims, and issue a new decision finding you became disabled on [insert date of proposed disability].
Why We Are Taking This Action
[Discuss the relevant findings made by the Administrative Law Judge and State agency (i.e., the sequential evaluation basis for the denial and allowance).]
[Specifically explain the basis for the proposed onset date. Also explain the basis for the unfavorable aspect of the decision to the extent necessary, e.g., proposing to adopt the Administrative Law Judge's relevant findings or stating the Appeals Council's basis for finding the claimant not disabled prior to the proposed onset date. Explain why the State agency's action was inappropriate (e.g., it invaded a period previously ruled on by an Administrative Law Judge).]
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 we plan to find you disabled.]
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:
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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 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.
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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]