II-6-6-10. SAMPLE Attachment to COR 18

TRANSMITTAL BY OFFICE OF
HEARINGS AND APPEALS

DATE:

TO:

[Insert Name and Address of Component]

FROM:

APPEALS COUNCIL

BY:

(Claimant's Name and SSN)

[Insert Claimant's Name and SSN]

(Wage Earner) (Leave blank if same as above)

ATTACHMENT(S):

• Claim File(s) (Title II)

• Claim File(s) (Title XVI)

• Appeals Council Notice

Please see the attached Appeals Council notice advising the claimant that the Form HA-520 has been treated as an appeal within your jurisdiction.

Please take any appropriate action and notify the claimant and the representative, if any.