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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 _____________________________________________________________ | |
|
Refer to: TAHB [SSN] [XSSN] |
Office of Hearings and Appeals 5107 Leesburg Pike Falls Church, VA 22041-3255] | |
NOTICE OF APPEALS COUNCIL DECISION
UNFAVORABLE
[Claimant's First Name, Middle Initial and Last
Name]
[Address]
[City, State
Zip]
The enclosed decision is the final decision of the Commissioner of Social Security in your case. Please read this notice and the decision carefully.
If You Disagree With This Decision
If you disagree with this decision, you may ask for court review by filing a civil action.
If you do not ask for court review, this decision will be a final decision that can be changed only under special rules.
[If foreign claim, replace court rights paragraphs with DENIAL SP 6]
How To File A Civil Action
You may file a civil action (ask for court review) by filing a complaint in the United States District Court for the judicial district in which you live. The complaint should name the Commissioner of Social Security as the defendant and should include the Social Security number(s) shown at the top of this letter.
You or your representative must deliver copies of your complaint and of the summons issued by the court to the U.S. Attorney for the judicial district where you file your complaint, as provided in rule 4(i) of the Federal Rules of Civil Procedure.
You or your representative must also send copies of the complaint and summons, by certified or registered mail, to:
The General CounselAnd:
The Attorney General of the United StatesTime To File A Civil Action
You have 60 days to file a civil action (ask for court review).
The 60 days start the day after you receive this letter. We assume you received this letter 5 days after the date on it unless you show us that you did not receive it within the 5-day period.
If you cannot file for court review within 60 days, you may ask the Appeals Council to extend your time to file. You must have a good reason for waiting more than 60 days to ask for court review. You must make the request in writing and give your reason(s) in the request.
You must mail your request for more time to the Appeals Council at the address shown at the top of this notice. Please put the Social Security number(s) also shown at the top of this notice on your request. We will send you a letter telling you whether your request for more time has been granted.
About the Law
The right to court review for claims under title II (Social Security) is provided for in Section 205(g) of the Social Security Act. This section is also Section 405(g) of Title 42 of the United States Code.
The right to court review for claims under title XVI (Supplemental Security Income) is provided for in Section 1631(c)(3) of the Social Security Act. This section is also Section 1383(c) of Title 42 of the United States Code.
The rules on filing civil actions are Rules 4(c) and (i) in the Federal Rules of Civil Procedure.
If You Have Any Questions
If you have any questions, you may call, write, or visit any Social Security office. If you do call or visit an office, please have this notice with you. The telephone number of the local office that serves your area is [Insert area code and number of servicing Field Office]. Its address is:
[Field Office Address]|
[Name] |
Enclosure:
[If there is a representative,
insert]:
cc:
[Representative's Name]
[Address]
[City,
State Zip]