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pdfSOCIAL SECURITY ADMINISTRATION
Refer To: [Clmt SSN]
[Clmt Name]
Office of Disability Adjudication and Review
[Local Office Address]
Tel: [Local Office Phone]/ Fax: [Local office
Fax]
[Current Date]
[OBO Name] on behalf of
[ClaimantFirstName][ClaimantLastName]
[OBO Address]
[ClaimantFirstName][ClaimantLastName]
[ClaimantAddress]
Dear [OBO Name] [Addressee]
The Appeals Council returned your case to us for further action. This letter
explains the hearing process and things that you should do now to get ready for your hearing.
The United States District Court returned your case to us for further
action. This letter explains the hearing process and things that you should do now to get ready for
your hearing. Thank you for your request for a hearing. We will
mail a Notice of Hearing to you at least 75 20 days before the date of
your hearing to tell you its time and place. Although we will make every effort to schedule your
hearing as soon as possible, there may be a delay. If you wish to discuss the status of your case,
you may call us or write to us. Our telephone number and address are at the top of this page.
We are required by the district court opinion dated May 28, 1985 in Martinez, et al. v. Secretary
of HHS, E.D.N.Y., No. 73 Civ. 900, to notify you of procedures available to you in the event of
unreasonable delay in processing your case. If, after requesting the status of your case, you
believe your case is being delayed unreasonably, you may apply to the United States District
Court for relief, including interim benefits.
The Appeals Council returned your case to us for further action. This letter
explains the hearing process and things that you should do now to get ready for your hearing.
We will send you a notice after we schedule your hearing. We will notify you at least
75 20 days before the date of your hearing. The notice will provide you with the
time and place of your hearing. We generally process requests for hearing by date order, with
the oldest receiving priority. However, we expedite cases returned from the Appeals Council.
We will schedule your hearing as soon as we can, which may take several months.
The United States District Court returned your case to us for further
action. This letter explains the hearing process and things that you should do now to get ready for
your hearing. We will send you a notice after we schedule your hearing. We will notify you at
least 75 20 days before the date of your hearing. The notice will provide
you with the time and place of your hearing. We generally process requests for hearing by date
order, with the oldest receiving priority. However, we expedite cases returned from the Federal
Courts. We will schedule your hearing as soon as we can, which may take several months.
Thank you for your request for a hearing before an administrative law
judge (ALJ). This letter explains the hearing process and things that you should do now to get
ready for your hearing. We will send you a notice after we schedule your hearing. We will notify
you at least 75 20 days before the date of your hearing. The notice will
provide you with the time and place of your hearing. We generally process requests for hearing
by date order, with the oldest receiving priority. We will schedule your hearing as soon as we
can, which may take several months.
Use of Video Teleconferencing (VTC) At Your Hearing
In certain situations, we hold your hearing by VTC rather than in person. We will let you
know ahead of time if we schedule your hearing by VTC.
If we schedule your appearance by VTC, you and the ALJ will be at different locations
during the hearing. A large, color monitor will enable you and the ALJ to see, hear, and
speak to each other. The ALJ will also be able to see, hear, and speak to anyone who
comes with you to the hearing. This may include your representative (if you have one), a
friend, or a family member. We will provide someone at your location to run the
equipment and provide any other help you may need.
You must let us know within 30 days after the date you receive this notice if you do
not want to appear at your hearing by VTC. (We may extend the 30-day period if you
show you had good cause for missing the deadline.) Please let us know by completing
and returning the attached form in the envelope we sent [if representative]your
representative[else]you[endif]. We will arrange for you to appear in person.
If you move before we hold your hearing, we retain the right to decide how you will
appear at your hearing, even if you objected to appearing by VTC. For us to consider
your change of residence when we schedule your hearing, you must submit evidence
proving your new residence.
Subsequent Application
Our records show that you have a prior application(s) pending at the Appeals Council.
We will not act on your current request for a hearing until the Appeals Council completes
its action on your prior application(s). The Appeals Council will complete its action as
soon as possible and send you a notice explaining the outcome.
•
If the Appeals Council denies or dismisses your request for review or makes a
partially favorable or unfavorable decision on your prior application(s), we will hold
a hearing on your current application(s). We will send you a Notice of Hearing at
least 75 20 days before the date of your hearing to tell you
its time and place.
•
If the Appeals Council decides to remand your prior application(s) for a new hearing,
we may combine your prior and current applications for the new hearing. We will
send you a Notice of Hearing at least 75 20 days before the
date of your hearing to tell you its time and place.
•
If the Appeals Council makes a favorable decision on your prior application(s) that
resolves all the issues in the current application(s), we will take no further action on
your new application(s).
The Hearing
At your hearing, you may present your case to the ALJ who will make the decision on
your claim(s). The ALJ will consider the issue(s) you raise, the evidence now in your file,
and any additional evidence you provide. The ALJ may also consider other issues,
including issues that were decided in your favor in the decision you appealed. The Notice
of Hearing will list the issues the ALJ plans to consider at the hearing.
Your hearing is the time to explain why you believe the ALJ should decide the issues in
your favor.
Your Right To Representation
You may choose to have a representative help you. We will work with this person just as
we would work with you. If you decide to have a representative, you should find one
quickly so that person can start preparing your case.
Many representatives charge a fee only if you receive benefits. Others may represent you
for free. Usually, your representative may not charge a fee unless we approve it. We are
enclosing a list of groups that can help you find a representative.
If you get a representative, you or that person must notify us in writing. You may use our
Form SSA 1696-U4 Appointment of Representative. Any local Social Security office
can give you this form.
Providing Additional Evidence
We need to make sure that your file has everything you want the ALJ to consider and any
other evidence the ALJ will need to decide your case. After the ALJ reviews the evidence
in your file, he or she may request more evidence to consider at your hearing.
If there is more evidence you want the ALJ to see, please give it to us as soon as possible.
We must receive any additional evidence no later than five business days before
the date of your hearing. The ALJ may choose to not consider the evidence if you fail to
provide it timely. Giving us evidence early can often help us review your case
sooner. If there is evidence you cannot give to us before the hearing, you may bring it to
the hearing.
We can help you get evidence you believe the ALJ should see. If you need help, contact
our office, your local Social Security office, or your representative (if you appoint one)
immediately.
If a physician, expert, or other person is not providing documents important to your case,
you may ask the ALJ to issue a subpoena. A subpoena is a special document that requires
a person to submit documents or to testify at your hearing. The ALJ will issue a subpoena
only if he or she thinks the evidence is necessary to decide your case, and the evidence
cannot be obtained another way. You must ask the ALJ to issue a subpoena at least 10 5 days before your hearing date. Send your request in writing to
the address at the top of the first page of this letter.
You May See The Evidence In Your File
If you wish to see the evidence in your file, you can see it on or before the date of your
hearing. If you wish to see your file before the date of your hearing, please call us as soon
as you reasonably can at the number at the top of the first page of this letter.
If You Have Any Questions Or Your Address Changes
If you have any questions, please call or write us. You must tell us if you change your
address. For your convenience, we gave you our telephone number and address on the
first page of this letter.
Sincerely yours,
[Signee Name]
[Signee Title]
Enclosures:
Claimant’s copy (if Spanish notice is not selected)
SSA Publication No. 05-10075 (Your Right To Representation) if no rep
HA-L1 (Important Notice Regarding Representation) if no rep
HA-L4 (What Happens Next) if What Happens Next is checked
HA-55 (Objection to Appearing by Video Teleconferencing)
HA-827 (Medical Release Notice) if Med. Release Notice and Form is checked
SSA-827 (Authorization to Disclose Information to SSA) if Med. Release Notice and Form is
checked
SSA Publication No. 70-067 (Why You Should Have Your Hearing By Video)
Representative’s copy
Form HA-L2 (Request for Hearing Acknowledgement Letter - Spanish) if Spanish notice is
checked
HA-L4-SP (What Happens Next - Spanish) if Spanish notice is checked and What Happens Next
is checked
HA-L4 (What Happens Next) if What Happens Next is checked
HA-55 (Objection to Appearing by Video Teleconferencing)
Form SSA-L1697-U3 (Acknowledgement of Representation)
Form HA-L32 (Electronic Disability Claims Processing Insert) if fully electronic
HA-827 (Medical Release Notice) if Med. Release Notice and Form is checked
SSA-827 (Authorization to Disclose Information to SSA) if Med. Release Notice and Form is
checked
SSA Publication No. 70-067 (Why You Should Have Your Hearing By Video)
Barcode Sheet if fully electronic
cc: [Rep First Name] [Rep Last Name]
[Rep Address]
Form HA-L2 (xx-2014)
OBJECTION TO APPEARING BY VIDEO TELECONFERENCING
Name: [Claimant Name]
Social Security Number: [Claimant SSN]
Wage Earner:
[Wage Earner]
Hearing Office: [Hearing Office]
I do not want to appear at my hearing by video teleconference. Please schedule my hearing so
that I may appear in person.
Additional Comments:________________________________________________________________________________________
Signature:
Date:
Area Code and Telephone Number:
Privacy Act Notice Sections 205(a), 205(c)(2) and 233 of the Social Security Act (40 U.S.C. § 405 and 433), and the Federal Records Act of
1950 (64 Stat. 583), authorizes us to collect the information contained on this form. The information you provide will be used to give the
employee credit for the correct amount of wages he or she earned in a given tax year. Completion of this form is voluntary. However, failure to
provide all or part of the requested information may affect the processing of this form and could prevent the employee form acquiring his or her
correct earnings information.
We rarely use this information provided on this form for any other purpose other than for the reasons explained above. However, we may use it
for the administration and integrity of Social Security programs. We may also disclose information to another person or to another agency in
accordance with approved routine uses, which include but are not limited to the following:
1. As a quarterly record detail file to provide data in wage investigation cases;
2. As a primary working record file of all SSN holders;
3. To record the latest employer of a wage earner;
4. To provide information to employers/former employers for correcting or reconstructing earnings records and for Social Security tax
purposes; and,
5. To facilitate statistical research, audit, or investigative activities necessary to assure the integrity of Social Security programs.
This information may be provided to the Internal Revenue Service for tax administration purposes or the Department of Justice for investigating
and prosecuting violations of the Social Security Act. In addition, we may also use this information you provided in computer matching
programs. Matching programs compare our records with records kept by other Federal, State or local government agencies. Information from
these matching programs can be used to establish or verify a person’s eligibility for Federally-funded and administered benefit programs.
A complete list of routine uses for this information is available in Systems of Records Notice, entitled, Earnings Recording and Self-Employment
Income System, Social Security Administration Office of Systems, 60-0059. The notice, additional information regarding this form, and
information regarding our programs and systems, are available on-line at www.socialsecurity.gov or at your local Social Security Office.
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the
Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget
control number. We estimate that it will take about 5 minutes to read the instructions, gather the facts, and answer the questions. You may send
comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to our time
estimate to this address, not the completed form.
Form HA-55 (xx-2014)
Why You Should Have Your Hearing By Video
If you are getting ready for a hearing before an
administrative law judge, Social Security offers
an efficient method using new technology—video
hearings. With video hearings, we can make the
hearing more convenient for you. Often an
appearance by video hearing can be scheduled
faster than an in-person appearance.
What is a video hearing?
A video hearing allows you and the other
hearing participants to see and hear each other
through large color television screens. The judge
remains in his or her office, and you go to a site
that can be more convenient to where you live. A
technician is there to make sure the equipment
works smoothly.
How is a video hearing scheduled?
If we are using video hearing equipment in your
area, we will contact you to schedule a video
appearance for you at a convenient time. The
judge will consider any preference you may have
expressed for or against appearing by video
teleconferencing when setting the time and place
of your hearing. You will have an opportunity to
object to the set time or place.
If you have any questions or want more
information, please contact your hearing office
when you receive your acknowledgment of your
request for a hearing.
How is a video hearing different?
Except for the equipment, a video hearing is no
different than a hearing at which you appear in
person. The judge can see you and speak with
you and anyone who comes to the hearing with
you, such as your representative or any witnesses.
You can see the judge and anyone who is with the
judge—or anyone at another video teleconference
site, such as a medical or vocational expert.
Transmission of the hearing is secure, and your
privacy is protected. We do not videotape
hearings, but we do make audio recordings—as
we do for all hearings.
What are the advantages of a
video hearing?
Often an appearance by video hearing can be
scheduled faster than an in-person appearance.
That means less waiting time. Also, a video
hearing location may be closer to your home.
That might make it easier for you to have
witnesses or other people accompany you.
www.socialsecurity.gov
Social Security Administration
SSA Publication No. 70-067
ICN 443300
Unit of Issue – HD (one hundred)
October 2004
File Type | application/pdf |
Author | 303756 |
File Modified | 2014-12-24 |
File Created | 2014-01-28 |