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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]]:
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Re: |
[Claimant's Name] v. Commissioner of Social Security U.S.D.C. for the [selects District, if appropriate] District of [State] [,] [Division] Civil Action Number [enter number] |
This is about the Administrative Law Judge's decision dated [insert date].
[Use in case of an incorrect request for review notice]
The notice attached to that decision was incorrect in telling you that you had 60 days to request review of the decision by the Appeals Council. The correct information concerning the decision is shown below.
[Use in case of an incorrect Sentence 6 notice]
The notice attached to that decision was incorrect in telling you that we would forward a copy of your record to the U.S. Attorney for filing with the Federal district court and that you would have the right to continue the original civil action on this case.
The court order that sent this case back to the Commissioner ended the court's review of the earlier decision.
If You Disagree With The Administrative Law Judge's Decision
Under our rules, you have 20 days to send us a statement about the facts and the law in this case.
We Will Not Act for 20 Days
If you have more information, you must send it to us within 20 days of the date of this letter.
Our address and FAX number are:
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ADDRESS: |
Appeals Council |
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FAX: |
[FAX #], Attn: Branch [#]. |
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 20 days, we will assume that you do not want to send us more information. If you want a Federal district court to review the Commissioner's final decision after remand by the court, you must file a new civil action.
If you do not ask for court review, the Commissioner's decision will be a final decision that can be changed only under special rules.
How To File A Civil Action
[If Title II foreign claim, replace court rights paragraphs {5} through {7} with DENIAL SP6]
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 Counsel
Social Security Administration
Room 617 Altmeyer Building
6401 Security Boulevard
Baltimore, MD 21235And:
The Attorney General of the United States
Washington, DC 20530
Time To File A Civil Action
You have 60 days to file a civil action (ask for court review).
The 60 days start the 21st 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 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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Hearings and Appeals Analyst |
Enclosure:
Self-addressed envelope
cc:
[Claimant's
Name]
[Address]
[City, State
Zip]
[If claimant is unrepresented, letter will be addressed to claimant and “cc” will be deleted.]