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].
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 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]