|
SOCIAL SECURITY ADMINISTRATION _____________________________________________________________ | |
|
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)
|
|
SOCIAL SECURITY ADMINISTRATION _____________________________________________________________ | |
|
Refer to: TAHB [SSN] [XSSN] |
Office of Hearings and Appeals 5107 Leesburg Pike Falls Church, VA 22041-3255] | |
[Claimant's First Name, Middle Initial and Last
Name]
[Address]
[City, State
Zip]
Dear [Mr./Ms. [Claimant's Last Name]]:
This is about your request for review of the Administrative Law Judge's [decision] OR [dismissal] OR [decision and dismissal].
Your Request for Review Was Filed Late
Under our rules, if you disagree with the Administrative Law Judge's action, you have 60 days to file a request for review.
The 60 days start the day after you receive the notice of the Administrative Law Judge's action. We assume that you received the notice within 5 days after the date on it unless you show us that you did not receive it within the 5-day period.
In your case, the notice of the Administrative Law Judge's action is dated [insert date]. Therefore, the last day you could file your request for review was [insert date].
You filed your request for review on [insert date]. There is no statement or other information about why you did not file the appeal on time.
What You Must Do
You should send us a statement showing the reason(s) why you did not file the request for review within 60 days. You should send us any evidence that supports your explanation.
You may also send us information about when you received the notice of the Administrative Law Judge's action.
What We Plan To Do
If you show that you did not receive notice of the Administrative Law Judge's action within 5 days after the date on it, the Appeals Council may find that your appeal is timely.
If you show that you had a good reason for filing late, the Appeals Council will extend the time period and find that your appeal is timely.
If you do not show that you had a good reason for filing late, the Appeals Council will dismiss your request for review.
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. We will not allow more time to send information except for very good reasons.
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 #], 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 30 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.
|
[Name] [Hearings and Appeals Analyst] OR [Branch Chief] |
Enclosure
Self-addressed envelope
cc:
[If there is a representative,
insert:
Representative's Name
Address
City, State
Zip]
Social Security Office
[Enter SSO City and
State]