I-4-8-80.Exhibit – AC Notice and Decision – ALJ Dismissal After Court Remand – Sentence 6 Case

Last Update: 1/11/17 (Transmittal I-4-60)



[Addressee] [for] [NOTE: If there is no addressee entry, this line will not be generated]

[Claimant Name]

[Claimant Address1]

[Claimant Address2]

[Claimant CSZ]

[If there is a representative, the address block below, instead of the above, is generated.]

[Rep Name]

[Attorney at Law]

[Rep Firm]

[Rep Address1]

[Rep Address2]

[Rep CSZ]

Re:[Claimant Name] v. Commissioner of Social Security

U.S.D.C. for the [User selects District, if appropriate] District of [State][,] [Division]

Civil Action Number [User keys in Number]


The Administrative Law Judge's notice of {dismissal OR recommended dismissal} dated [User keys in date] told you that the Appeals Council may decide on its own to review the dismissal within 60 days. We are writing to tell you that we are assuming jurisdiction of your case under our rules. We are also enclosing a decision. Please read this notice and the decision carefully.


What We Plan To Do

We plan to make the attached decision the final decision of the Commissioner of Social Security after court remand in your case, unless we hear from you within 30 days.


We Will Not Act for 30 Days

If you do not agree with the attached decision, you must tell us within 30 days that you do not agree. To do so, you must send us a statement about the facts and the law in this case within 30 days of the date of 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.

Our address and FAX number are:


Appeals Council
ATTN: CCPRB [BranchNo], Suite [Ste No]
5107 Leesburg Pike
Falls Church, VA 22041-3255


[Fax No], Attn: CCPRB [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. After 30 days, the attached decision becomes the final decision of the Commissioner of Social Security after remand by the court.

We will then prepare a certified copy of the administrative record and send it to the U.S. Attorney to file with the court. If you have any questions about the court case, you would then have to contact the district court.


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.

[Judge Name1]

[Acting] Administrative Appeals Judge



[If claimant is unrepresented, the cc: lines below will not be generated]

[Addressee] [for] [NOTE: If there is no addressee entry, this line will not be generated]

[Claimant Name]

[Claimant Address1]

[Claimant Address2]

[Claimant CSZ]



In the case of

Claim for

[Claimant Name]

[Claim for]





(Wage Earner) (Leave blank if same as above)

(Social Security Number)



This case is before the Commissioner on remand from the United States District Court for (Fill in: district), Civil Action Number (Fill in: civil action number). The court directed the Commissioner on remand to (Fill in: explanation of proceedings required by court order).


The Appeals Council vacated the Commissioner's prior final decision in this case and remanded the case for further proceedings in accordance with the court's order. On (Fill in: date), the claimant (and his/her representative) (was/were) notified of the time and place of the scheduled hearing (Fill in: Exhibit No.). (Fill in: explanation of facts surrounding abandonment) (Fill in: Exhibit(s) No.). OR (The claimant or The claimant, through his/her representative,) responded by (Fill in: letter/telephone) on (Fill in: date) that (he/she) did not wish to pursue the claim (Fill in: Exhibit No.).

{3} [Choose {a} or {b}]

{a} The Administrative Law Judge dismissed the request for hearing by order dated (Fill in: date). OR {b} The Administrative Law Judge recommended that the request for hearing be dismissed by order dated (Fill in: date).


However, because the court remanded the claim to the Commissioner under sentence six of section 205(g) of the Social Security Act, the Commissioner must modify or affirm the Commissioner's findings of fact or the

Commissioner's decision.

{5} [Choose {a} or {b}]

{a}The Appeals Council, therefore, has decided on its own motion to review the dismissal order under authority of 20 CFR 404.969 and/or 416.1469. OR {b} The Appeals Council, therefore, has decided to reject the recommended dismissal under authority of 20 CFR 404.979 and/or 416.1479.

The claimant's action (abandoning / withdrawing) the (claim / request for hearing) renders the controversy moot, thereby making additional proceedings unnecessary. Therefore, the Appeals Council adopts, as herein modified, the findings and conclusions in the decision of (Fill in: date of previously vacated ALJ decision).

It is the decision of the Appeals Council that, based on the application(s) filed on (Fill in: date(s)), the claimant is not (entitled to OR eligible for OR entitled to or eligible for) (Fill in: type of benefit(s), e.g., a period of disability or disability insurance benefits AND/OR Supplemental Security Income payments) under section(s) (Fill in: applicable

sections) of the Social Security Act.



[Judge Name1]

Administrative Appeals Judge


[Judge Name 2]

Administrative Appeals Judge