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II-6-6-3. COR 12 Letter Re Claimant's Responsibility to Submit Evidence — ALJ Decision (All Titles)

	SOCIAL SECURITY ADMINISTRATION _____________________________________________________________
	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]

In the request for review, you [asked us to obtain evidence from [identify source]] [and] [told us that evidence is available from [identify source]].

Under our rules, the claimant is responsible for sending us evidence [he/she] wants us to consider.

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:

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.

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.]

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