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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]
Enclosed are the [copies of the exhibits] [and] [duplicate recording/recordings] you asked for. [If other enclosures add: We are [also] enclosing [specify anything else enclosed]].
[If exhibits and/or recordings are not available, replace above or add as appropriate: You [also] asked that we send you [copies of the exhibits] [and] [duplicate recording(s)]. [Because the Administrative Law Judge dismissed the request for hearing, no exhibits were entered into the record.] AND/OR [The/Also, the] Administrative Law Judge did not hold a hearing in this case. Therefore, there is no hearing recording.]
[If no enclosures are being sent, replace all of the above with:]
We have granted your request for more time before we act on your case.
You May Send More Information
You may send us more evidence or a statement about the facts and the law in this case.
Any more evidence must be new and material to the issues considered in the hearing decision dated [insert date of decision].
We Will Not Act For 25 Days
If you have more information, you must send it to us within 25 days of the date of this letter. We will not allow more time to send information except for very good reasons.
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 [#]. |
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 25 days, we will assume that you do not want to send us more information. We will then proceed with our action based on the record we have.
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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[Branch Chief] OR [Hearings and Appeals Analyst] OR [Paralegal Support Technician] OR [Legal Assistant] |
Enclosures:
[Identify
enclosures]
Self-addressed
envelope
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.]