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]
[If ALJ decision, insert:]
The Administrative Law Judge's notice of favorable decision dated [insert date] told you that the Appeals Council may decide on its own to review the decision within 60 days.
[If SSA decision, insert:]
The Senior Staff Attorney's notice of favorable decision dated [insert date] told you that the Appeals Council may decide on its own to review the decision within 60 days after the date of the Administrative Law Judge's Order of Dismissal. The Order of Dismissal is dated [insert date].
[If AO decision, insert:]
The Adjudication Officer's notice of favorable decision dated [insert date] told you that the Appeals Council may decide on its own to review the decision within 60 days.
We Are Reviewing the Hearing Decision
We are writing to tell you that we are reviewing the decision in your case.
[If separate action being taken, insert:]
This letter is only about your claim for [insert claim type]. We are not changing the hearing decision about your claim for [insert claim type].
[If short form own motion notice previously sent, replace all of the above with:]
In an earlier letter dated [insert date], we told you that we are reviewing the [Administrative Law Judge's] OR [Senior Staff Attorney's] OR [Adjudication Officer's] decision dated [insert date] [about your claim[s] for [identify claim type(s) only if AC is taking separate actions]. Now we are writing to tell you more about this review.
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] OR [Senior Staff Attorney] OR [Adjudication Officer] [and the testimony at the hearing].
[If protest case, insert:]
We also considered the enclosed memorandum from the [Office of Disability and International Operations] OR [Office of Quality Assurance and Performance Assessment] OR [Insert source].
[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 the Administrative Law Judge's dismissal order] and send your case back to an Administrative Law Judge for more action and a new 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, and what further proceedings the AC is directing on remand. If protest case involving work after onset, use SP 3 RV.]
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.
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 send your case back to an Administrative Law Judge.
You May Receive Benefits While We Are Reviewing Your Case
Under Section 8001 of Public Law 100-647, the Social Security Administration must pay interim benefits if we have not made a final decision within 110 days after the date of an Administrative Law Judge's favorable decision. Because we are reviewing the hearing decision, you may receive interim benefits if we do not make a final decision within that time. If you receive interim benefits, they will continue until we make a final decision.
If you are due interim benefits, another office will let you know how much they are and when you will receive them.
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]