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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] Social Security Number: [Insert SSN] Address: [Insert Claimant's Address] Phone No.: [Insert Claimant's Phone No.] |
On [insert date], the Administrative Law Judge issued a [decision] OR [dismissal] OR [decision and dismissal]. On [insert date], the claimant filed a request for review. However, there is no statement or other information in the file about why the request was filed late.
Please obtain a signed statement from the claimant setting forth the reasons for the delay. Also, please send any information or evidence in your office that may be helpful to us in determining whether there was good cause for late filing.
If the claimant does not cooperate in providing the information, please document your efforts to obtain the information and send this documentation and copies of any letters to the claimant to the Appeals Council.
If you learn that the claimant now has a representative, all contacts with the claimant should be through the representative.
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] |