II-6-6-46. SAMPLE 3 Attachment to COR 44

TRANSMITTAL BY OFFICE OF HEARINGS AND APPEALS

DATE:

TO:

[Insert Name and Address of Component]

FROM:

APPEALS COUNCIL

BY:

(Claimant's Name and SSN)

[Insert Claimant's Name and SSN]

(Wage Earner) (Leave blank if same as above)

ATTACHMENT(S):

____ Claim File(s) (Title II)

____ Claim File(s) (Title XVI)

____ Appeals Council Notice

We are forwarding to you additional evidence sent by the Appeals Council to decide whether it warrants reopening and revision of your prior action.

Please take appropriate action and notify the claimant and the representative, if any.