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 the [Administrative Law Judge's] OR [Senior Staff Attorney's] OR [Adjudication Officer's] decision dated [insert date].
We Are Reopening and Revising the Hearing Decision
We are writing to tell you that we looked at your case again to see if the decision was correct. After considering all of the information, we are changing the decision.
[If separate actions being taken, insert:]
This letter is only about your claim[s] for [insert claim type]. We are not changing the hearing decision about your claim[s] 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 changing 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 may reopen (look again at) and change a decision 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 decision in your case for any of the following reasons.
New and material evidence.
A clerical error.
The evidence considered in making the decision 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] 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 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 criteria for reopening are met and why the AC disagrees with the hearing decision.]
[Use SP 4 RV, if issue is insured status.]
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:
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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.
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]