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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] | |
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] | |
[Representative's First Name, Middle Initial and Last
Name]
[Address]
[City, State
Zip]
Dear [Mr./Ms. [Representative's Last Name]]:
Re: [Claimant's Name and Address]
Earlier, we prepared a Form HA-520, Request for Review of Hearing Decision/Order in this case. We did this based on a letter [identify correspondence including the date if available].
After further study, we find that this letter did not ask for Appeals Council review but instead [briefly describe nature of request].
[As necessary, further discuss correspondence here.]
The Appeals Council will not take any action on this case unless you file a request for review.
Time To File A Request for Review
You must file a request for review within 60 days after you receive notice of the Administrative Law Judge's action.
If you cannot file a request for review within 60 days you may ask the Appeals Council to extend your time to file.
If You Have Any Questions
If you have any questions, you may call, write, or visit any Social Security office. If you do call or visit an office, please have this notice with you. The telephone number of the local office that serves your area is [Insert area code and number of servicing Field Office]. Its address is:
[Field Office Address]
[City, State ZIP]
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[Name] [Hearings and Appeals Analyst] OR [Branch Chief] |
cc:
[Claimant's
Name]
[Address]
[City, State
Zip]
[If claimant is unrepresented, letter will be addressed to claimant and “Re” line and “cc” will be deleted.]