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 Telephone: 703-605-8000 Date: [Month, Day, Year] | |
NOTICE OF APPEALS COUNCIL ACTION
[Claimant's First Name, Middle Initial and Last Name]
[Address]
[City, State Zip]
This is about your request for review of the Administrative Law Judge's [decision] OR [dismissal] OR [decision and dismissal] dated [insert date]. [If good cause for untimely filing is found insert SP 1 RV]
This is also about the favorable determination dated [insert date] on your later claim(s).
[If taking separate action on another title insert SP 2 RV.]
We Have Granted Your Request for Review
The Appeals Council is reviewing the Administrative Law Judge's [decision] OR [dismissal] OR [decision and dismissal].
Rules We Applied
Under our rules, we will review your case for any of the following reasons.
The Administrative Law Judge appears to have abused his or her discretion.
There is an error of law.
The decision is not supported by substantial evidence.
There is a broad policy or procedural issue that may affect the public interest.
We receive new and material evidence and the decision is contrary to the weight of all the evidence now in the record.
In your case, we found that [there is an error of law] AND/OR [the decision is not supported by substantial evidence] AND/OR [there is new and material evidence and the decision is contrary to the weight of all the evidence now in the record].
We Are Reopening the Favorable Determination
We looked at your case to see if the favorable determination was correct. After considering all of the information, we plan to combine the two cases and send them back to an Administrative Law Judge for more action and a new decision.
[Use the following paragraph if separate actions are being taken:]
This letter is only about reopening your favorable claim for Social Security benefits. We are not changing the favorable determination about your claim for Supplemental Security Income.
Rules We Applied
Under our rules, we may reopen (look again at) and change a determination within the following time limits.
Within 12 months of the date of the notice of the initial determination for any reason.
Within 2 years of the date of the notice of the initial determination in a Supplemental Security Income claim if there is “good cause.”
Within 4 years of the date of the notice of the initial determination in a Social Security claim if there is “good cause.”
We will find there is “good cause” to take another look at the determination in your case for any of the following reasons.
New and material evidence.
A clerical error.
The evidence considered in making the determination clearly shows that there was an error.
In your case, the notice[s] of the initial determination[s] [is/are] dated [insert date].
What We Considered
We considered the written record that was before the Administrative Law Judge [the testimony at the hearing] and the record considered with the favorable determination.
[If proffering additional evidence, insert:]
We are enclosing a copy of more evidence that we are adding to the record of your case. [We are also sending a copy to your representative.]
What We Plan To Do
We plan to set aside the hearing decision, combine the claims, and send them back to an Administrative Law Judge for more action and a new decision.
Why We Are Taking This Action
[Discuss the relevant findings made by the Administrative Law Judge and State agency, i.e., the sequential evaluation basis for the denial and allowance.]
[Briefly state the reasons for the Appeals Council (AC) action and what further proceedings the AC will direct on remand, i.e., the primary evidence considered by the Administrative Law Judge in reaching his or her conclusion; the evidence the State agency relied upon to reach their conclusion; why the AC concludes that further development is needed; and what further development is required on remand.]
You May Send More Information
You may send us more evidence or a statement about the facts and the law in your case within 30 days of the date of this letter.
You May Ask For An Appearance
You may ask for an appearance before the Appeals Council to tell us about your case. You must tell us in writing within 30 days from the date of this letter why you want an appearance.
Under our rules, we will give you an appearance if:
There is an important question of law or policy;
OR
Oral argument would help us reach a proper decision.
If we decide to give you an appearance, we will notify you about the time and place at least 10 days before the date scheduled for your appearance.
We Will Not Act For 30 Days
If you have more information, you must send it to us within 30 days of the date of this letter.
Our address and FAX number are:
| ADDRESS: |
Appeals Council Office of Hearings and Appeals ATTN: Branch [#], Suite [#] 5107 Leesburg Pike Falls Church, VA 22041-3255 |
| FAX: |
[Fax No], Attn: Branch [Branch No] |
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 30 days, we will assume that you do not want to send us more information or appear before the Appeals Council. We will then send your case back to an Administrative Law Judge.
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] | |
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Administrative Appeals Judge |
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[Name] |
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Administrative Appeals Judge |
Enclosure[s]:
[List additional
evidence being proffered]
Self-addressed envelope
[If there is a representative,
insert:]
cc:
[Representative's
Name]
[Address]
[City, State
Zip]