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].
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 Happens Next
We will soon send you another letter telling you what we plan to do, the reason for our action, and your rights in this review.
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]