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 recommended decision dated [insert date].
[If taking separate action on another title insert SP 2 RV.]
We are Prepared to Issue a Final Decision
We are writing to tell you that we plan to issue a final decision that [adopts] OR [modifies] OR [does not adopt] the Administrative Law Judge's recommended decision.
Rules We Applied
Under our rules, the Appeals Council must review a record in which a recommended decision was issued and either issue a final decision or send the case back to an Administrative Law Judge for more action and a new decision.
What We Considered
We considered the written record that was before the Administrative Law Judge [and the testimony at the hearing].
[Use this paragraph if claimant submits contentions and/or additional evidence]
We also considered [your reasons for disagreeing with the Administrative Law Judge's recommended decision] [and] [additional evidence you submitted to the Appeals Council].
[Use this paragraph if proffering additional evidence]
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 final decision that [adopts] OR [modifies] OR [does not adopt] the Administrative Law Judge's recommended decision. [Explain the basis for the Appeals Council's action, discussing what the Administrative Law Judge's recommended decision found and why the Appeals Council agrees or disagrees.]
Why We Are Taking This Action
[Enter rationale for the Appeals Council's final decision. If the decision is partially favorable, explain the basis for the favorable aspect and the unfavorable aspect, e.g., adopting the Administrative Law Judge's relevant findings or stating the AC's basis for modifying or not adopting such findings.]
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 AC is finding a later onset date, insert:]
We will consider more evidence if:
It is new and material;
AND
It is about “disability” starting before [insert date], the date we plan to find you disabled.
[If DLI expired (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 date], the date you were last insured for disability benefits.
[If DLI expired (concurrent 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 date] , 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.
[If there are 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, insert:]
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:
| ADDRESS: |
Appeals Council Office of Hearings and Appeals ATTN: Branch [#], Suite [#] 5107 Leesburg Pike Falls Church, VA 22041-3255 |
| FAX: |
[Fax No], Attn: Branch [Branch No] |
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]