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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] | |
[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 dismissal in your case. The Administrative Law Judge dismissed your request for hearing because you did not file the request within 60 days of the date you received the notice of reconsideration and you did not have a good reason for filing late.
What You Must Do
The issue before the Appeals Council is whether there is good cause for not filing your request for hearing within 60 days.
Your request for review does not give reasons why you did not file the appeal on time and there is no other information in the record showing why you filed late.
You should send us a statement showing the reasons why you did not file your request for hearing on time. You should also send us any evidence that supports your explanation.
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:
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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 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.
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[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]