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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] | |
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MEMORANDUM TO: |
Social Security Office [Insert mailing address] |
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FROM: |
Office of Appellate Operations Branch[#] |
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SUBJECT: |
Request for Assistance in Pending Request for Review - ACTION Claimant: [Insert Claimant's Name](Deceased) Social Security Number: [Insert SSN] Last Known Address: [Insert Claimant's Address] Last Known Phone No.: [Insert Claimant's Phone No.] |
On [insert date], the claimant filed a request for review which is pending before the Appeals Council. We have been notified that the claimant died on [insert date].
[If proof of death needed insert:]
[Please provide the Appeals Council with proof of the claimant's death.]
In order to proceed with the case, the Appeals Council [also] needs information as to whether there is an adversely affected party who wishes to continue the action (See 20 CFR 404.971(b)).
If a survivor's claim has been filed, please provide us with the information regarding the claim and its status. If the survivor's claim has been approved, this information may be sufficient to establish that there is an adversely affected party.
If there is no survivor's claim, any individual who wishes to continue the action must prove his or her relationship, or monetary interest, or that his or her rights may be prejudiced. Under the Social Security Act, the legal representative of the deceased's estate may be an adversely affected party because, under certain conditions, an underpayment resulting from a favorable decision may be paid to the estate.
If there is an adversely affected party who wishes to continue the action, please have him or her complete the attached form “Request for Designation as a Substitute Party in a Proceeding Before the Appeals Council.”
If a survivor indicates that he or she does not wish to continue the action, please obtain a signed statement to this effect.
Please return all material directly to the Appeals Council within 30 days from the date of this memorandum.
Our address and FAX number are:
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ADDRESS: |
Appeals Council Office of Hearings and Appeals ATTN: Branch [#], Suite [#] 5107 Leesburg Pike Falls Church, VA 22041-3255 |
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FAX: |
[FAX #], Attn: Branch [#]. |
Please include the claimant's Social Security Number on all correspondence.
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[Name] [Hearings and Appeals Analyst] OR [Branch Chief] |
Attachment:
Request for Designation as a Substitute Party