I-4-3-114.Sample — Memorandum to Field Office With Copy of Posthearing Evidence

Last Update: 9/13/05 (Transmittal I-4-15)

 

Social Security Administration

 

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Refer to:

 

Office of Hearing and Appeals
5107 Leesburg Pike
Falls Church, VA 22041- 3200

MEMORANDUM TO FIELD OFFICE WITH COPY OF POSTHEARING EVIDENCE

MEMORANDUM TO:

Social Security Office
(_____Address______)

FROM:

Administrative Appeals Judge,
___________
OHA
5107 Leesburg Pike
Falls Church, VA 22041-3255

SUBJECT:

(______Claimant_____)
(_____000-00-0000_____)

I have attached a copy of a letter notifying the claimant that I have received additional evidence which I propose to include in the record of the case.

Please inform the claimant that the additional evidence will be available for examination at your office for a period of 10 days from the date of your letter. Please send me a copy of your letter to the claimant.

Because the case is now within my jurisdiction, personnel in your office are not permitted to discuss this material with the claimant or provide the claimant with copies of the additional evidence. Any specific request from the claimant for copies of the evidence must be recorded on the enclosed “Examination of Evidence” form. I will take the necessary action to respond.

If the claimant examines the evidence, have him complete Item A of the attached “Examination of Evidence” form. The claimant should then sign and date the form in the appropriate spaces. If there is no response to your 10-day letter, please sign and date Item B.

Upon completion of your action, all material must be returned to this office in the attached envelope. This case is now pending at the Appeals Council level. Your prompt attention to the request is appreciated.

Administrative Appeals Judge's Name

Attachments:

  1. Copy of Letter to Claimant

  2. List of Additional Evidence

  3. Copy of Additional Evidence

  4. Examination of Evidence Form

  5. Self-addressed Envelope