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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 _____________________________________________________________ | |
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Refer to: TAHB [SSN] [XSSN] |
Office of Hearings and Appeals 5107 Leesburg Pike Falls Church, VA 22041-3255] | |
[Representative's First Name, Middle Initial and Last
Name]
[Address]
[City, State
Zip]
Dear [Mr./Ms. [Representative's Last Name]]:
Re: [Claimant's Name and Address]
On [insert date], the Appeals Council [denied] OR [dismissed] a request for review of the Administrative Law Judge's [decision] OR [dismissal] OR [decision and dismissal]. The Council has now received a second request for review of the same [decision] OR [dismissal] OR [decision and dismissal].
Under our rules, a person may request review of an Administrative Law Judge's [decision] OR [dismissal] OR [decision and dismissal] only once. Because you are not allowed to file a second request for review, we will take no action on it.
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]
[City, State ZIP]
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[Name] [Hearings and Appeals Analyst] OR [Branch Chief] |
cc:
[Claimant's Name]
[Address]
[City, State
Zip]
[If claimant is unrepresented, letter will be addressed to claimant and “Re” line and “cc” will be deleted.]