II-6-1-42. SAMPLE HA-505 Transmitting New Application to SSA Field Office for Adjudication (Use With Denial SP 7)

TRANSMITTAL BY OFFICE OF HEARINGS AND APPEALS

DATE:

TO:
Social Security Administration
[Insert FO mailing address]

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):
____ Title II Application
____ Title XVI Application
____ Appeals Council Notice

The Appeals Council has denied the claimant's request for review.

The attached material was forwarded to the Council for coordination with its action on the request for review. We are returning it to you for necessary action. The claimant has been advised of this action in the denial notice.

The Appeals Council must retain the claim file(s) for 120 days in the event of a civil action.