Notice of Bench Decision

SOCIAL SECURITY ADMINISTRATION
Refer To: [Claimant Name]

Office of Disability Adjudication and Review
[Hearing Office Address]
Date: Date

Notice of Decision –Fully Favorable
I carefully reviewed the facts of your case and made a fully favorable decision on your
application(s) for a period of disability and disability insurance benefits filed on [Application
Date]. I stated the basis for my decision at your hearing held on [Date of Hearing]. I adopt the
findings of fact and reasons that I gave at the hearing. Please read this notice of decision.
Conditional Language Step 3
I found you disabled as of [Date of Disability Onset]. Your impairment or combination of
impairments is so severe that it meets the requirements of one of the impairments listed in the
Listing of Impairments.
Conditional Language Step 5
I found you disabled as of [Date of Disability Onset] because your impairment or combination of
impairments is so severe that you cannot perform any work existing in significant numbers in the
national economy.
If you would like more information about my decision, I can provide you with a record of my
oral decision. You must ask for this record in writing. You may mail or bring your request to any
Social Security or hearing office. Please put the Social Security number shown above on your
request.
Another office will process my decision and decide if you meet the non-disability requirements
for Supplemental Security Income payments. That office may ask you for more information. If
you do not hear anything within 60 days of the date of this notice, please contact your local
office. The contact information for your local office is at the end of this notice.
If You Disagree With My Decision
If you disagree with my decision, you may file an appeal with the Appeals Council.
How To File An Appeal
To file an appeal you must ask in writing that the Appeals Council review my decision. You may
use our Request for Review form (HA-520) or write a letter. The form is available at
Form HA-82 (07-2011)

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(Claimant Name)

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www.socialsecurity.gov. Please put the Social Security number shown above on any appeal you
file. If you need help, you may file in person at any Social Security or hearing office.
Please send your request to:
Appeals Council
Office of Disability Adjudication and Review
5107 Leesburg Pike
Falls Church, VA 22041-3255
Time Limit To File An Appeal
You must file your written appeal within 60 days of the date you get this notice. The Appeals
Council assumes you got this notice 5 days after the date of the notice unless you show you did
not get it within the 5-day period.
The Appeals Council will dismiss a late request unless you show you had a good reason for not
filing it on time.
What Else You May Send Us
You may send us a written statement about your case. You may also send us new evidence. You
should send your written statement and any new evidence with your appeal. Sending your
written statement and any new evidence with your appeal may help us review your case sooner.
How An Appeal Works
The Appeals Council will consider your entire case. It will consider all of my decision, even the
parts with which you agree. Review can make any part of my decision more or less favorable or
unfavorable to you. The rules the Appeals Council uses are in the Code of Federal Regulations,
Title 20, Chapter III, Part 404 (Subpart J) and Part 416 (Subpart N).
The Appeals Council may:
•
•
•
•

Deny your appeal,
Return your case to me or another administrative law judge for a new decision,
Issue its own decision, or
Dismiss your case.

The Appeals Council will send you a notice telling you what it decides to do. If the Appeals
Council denies your appeal, my decision will become the final decision.
The Appeals Council May Review My Decision On Its Own
The Appeals Council may review my decision even if you do not appeal. They may decide to
review my decision within 60 days after the date of the decision. The Appeals Council will mail
you a notice of review if they decide to review my decision.
Form HA-82 (07-2011)

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(Claimant Name)

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When There Is No Appeals Council Review
If you do not appeal and the Appeals Council does not review my decision on its own, my
decision will become final. A final decision can be changed only under special circumstances.
You will not have the right to Federal court review.
If You Have Any Questions
We invite you to visit our website located at www.socialsecurity.gov to find answers to general
questions about social security. You may also call (800) 772-1213 with questions. If you are
deaf or hard of hearing, please use our TTY number (800) 325-0778.
If you have any other questions, please call, write, or visit any Social Security office. Please
have this notice and decision with you. The telephone number of the local office that serves your
area is Field Office Phone Number. Its address is:
Field Office Address

ALJ Name
Administrative Law Judge

Date

Form HA-82 (07-2011)