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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 a request for review of an Administrative Law Judge's decision] OR [issued a decision]. The Council has now received your request for more time to file a civil action (ask for court review).
We Are Giving You More Time to File a Civil Action
The Appeals Council now extends the time within which you may file a civil action (ask for court review) for [30] OR [insert days] from the date you receive this letter. We assume that 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.
[Insert the following if materials are enclosed:
As requested, we are enclosing [enter description of enclosures].
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] |
Enclosures:
[Identify
enclosures]
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.]