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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]
On [insert date], the Appeals Council [denied a request for review of the Administrative Law Judge's decision] OR [issued a decision]. The Council has now received your request for [copies of exhibits] [and] [,] [duplicate recording(s)] [and] [more time]. [We are enclosing the materials you requested].
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 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 25 days, we will assume that you do not want to send us more information. The [Administrative Law Judge's decision] OR [Appeals Council's decision] dated [insert date]] will stand as the final decision of the Commissioner of Social Security on the application[s] dated [insert date(s)].
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] |
Enclosures:
[Photocopies of exhibits]
[Duplicate
recording(s)]
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.]