Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions

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1	C	MCS APPEAL DISPOSITION DISP SD38
2	0
3	l	NH: SSSSSSSSS SSSSS SSSSSSSSSS CL: SSSSSSSSS SSSSS SSSSSSSSSS
4	u	SELECT DISPOSITION: X
5	m	1=UNFAVORABLE DENIAL 4=DISMISSAL 7=ABANDON.
6	n	2=PARTIALLY FAVORABLE ALLOW 5=WITHDRAWAL
7	*	3=FULLY FAVORABLE ALLOW 6=REMAND
8	o
9	n	DISPOSITION DATE: XXXXXXXX EFFECTUATION DATE: XXXXXXXX
10	e
11		ALJ: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX ALJ HO: XXXX
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13	e
14	s
15	e
16	r
17	v
18	e
19	D
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24		**************(Line 24 Reserved for Operating Systems Information)***********

DISP – Appeal Disposition Screen

HNG1 – Hearing Request 1

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1	C	MCS HEARING REQUEST 1 HNG1 SD3
2	0	NH SSSSSSSSS SSSSS SSSSSSSSSS CL SSSSSSSSS SSSSS SSSSSSSSSS
3	l	CROSS REFERENCE SSN: SSSSSSSSS BIC: SS SSN: SSSSSSSSS BIC: SS
4	u	APPELLANT (IF OTHER THAN CLMT OR REP): XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
5	m	ADDRESS: XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXX
6	n	XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXX
7	*	CITY: XXXXXXXXXXXXXXXXXX STATE: XX ZIP: 99999 PHONE: 999 999 9999
8	o	COUNTRY: XXXXXXXXXXXXXXXXXXXXXX CONSUL CODE: 999
9	n	FOREIGN POSTAL ZONE: 999999999999999
10	e	BIC: XX SPOUSE SSN: 999999999 CASE TYPE: 9 1. INITIAL ENT
11		SELECT APPEAL CLAIM TYPE: 9 9
12	r	1=RSI RSI 5=SSI BLIND/TITLE II SSBC
13	e	2=DISABILITY WORKER OR CHILD DIWC 6=SSI DISABILITY/TITLE II SSDC
14	s	3=DISABILITY WIDOW(ER) DIWW 7=HEALTH INS ENT HIE
15	e	4=SSI AGED/TITLE II SSAC 8=OTHER.
16	r	HEARING REQUESTED (Y/N): X
17	v	REASON HEARING REQUESTED: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
18	e	XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
19	d	XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
20		XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
21		ADDITIONAL EVIDENCE (Y/N/F): X
22
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24		**************(Line 24 Reserved for Operating Systems Information)***********

HNG2 – Hearing Request 2

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1	C	MCS HEARING REQUEST 2 HNG2 SD3	7
2	0	NH SSSSSSSSS SSSSSSSSSSSSSSSS CL SSSSSSSSS SSSSSSSSSSSSSSSS
3	l	REQUEST ORAL HEARING (Y/N): X REASON HEARING WAIVED: XXXXXXXXXXXXXXXXXXXX
4	u	XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
5	m	XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
6	n	XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
7	*	REPRESENTED (Y/N): X IF NO, LEGAL REFERRAL LIST TO CLMT (Y/N): X
8	o	ATTORNEY/REP NAME: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX IF YES, ATTY (Y/N):
9	n	ATTORNEY/REP ADDRESS: XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXX
10	e	XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXX
11		CITY: XXXXXXXXXXXXXXXXXX STATE: XX ZIP: 99999 PHONE: 999 999 9999
12	r	COUNTRY: XXXXXXXXXXXXXXXXXXXXXX CONSUL CODE: 999
13	e	FOREIGN POSTAL ZONE: 999999999999999
14	s	SELECT FILED BY: 9 1=APPELLANT 2=REP. DATE FILED: 99999999
15	e	DETER DATE BEING APPEALED: 99999999 TIMELY REQUEST (Y/N): X
16	r	SELECT IF NO,: 9
17	v	1=CLMT’S EXPLANATION 2=OTHER INFORMATION 3=BOTH 1 AND 2 APPLY.
18	e	EXPLANATION: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
19	d	XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
20		XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
21		XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
22		INTERPRETER (Y/N): X IF YES, SPECIFY LANGUAGE: XXXXXXXXXXXXXXXXXXXXXX
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24		**************(Line 24 Reserved for Operating Systems Information)***********

NAPP – Appeal Establishment

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1	C	MCS APPEAL ESTABLISHMENT NAPP SM2	0
2	0	NH NAME: SSSSSSSSSS S SSSSSSSSSSSSSSSSSSS NH SSN: SSSSSSSSS
3	l
4	u	APPEAL FILE LEVEL: 9 1. RECON 2. HEARING 3.FEDRO REVIEW
5	m	LEV: I INITIAL DECISION STATUS:
6	n	R RECON 1 RSHI ALLOW 5 DIB MED DENY 9 RSHI PARTIAL
7	*	H HEARING 2 RSHI DISAL 6 NON-MED COMP 10 DIB PARTIAL
8	o	O REOPEN 3 DIB TECH DIS 7 WITH/ABATE 11 DISMISSAL
9	n	F FEDRO 4 DIB ALLOW 8 DELAY
10	e	FILE ADJ
11		CL NAME CL SSN DATE DEC DATE LEV SELECT
12	r	01. SSSSSSSSSS S SSSSSSSSSSSSSSSSSSS SSSSSSSSS SSSSSS SS SSSSSS F X
13	e	02. SSSSSSSSSS S SSSSSSSSSSSSSSSSSSS SSSSSSSSS SSSSSS SS SSSSSS S X
14	s	03. SSSSSSSSSS S SSSSSSSSSSSSSSSSSSS SSSSSSSSS SSSSSS SS SSSSSS S X
15	e	04. SSSSSSSSSS S SSSSSSSSSSSSSSSSSSS SSSSSSSSS SSSSSS SS SSSSSS S X
16	r	05. SSSSSSSSSS S SSSSSSSSSSSSSSSSSSS SSSSSSSSS SSSSSS SS SSSSSS S X
17	v	06. SSSSSSSSSS S SSSSSSSSSSSSSSSSSSS SSSSSSSSS SSSSSS SS SSSSSS S X
18	e	07. SSSSSSSSSS S SSSSSSSSSSSSSSSSSSS SSSSSSSSS SSSSSS SS SSSSSS S X
19	d	08. SSSSSSSSSS S SSSSSSSSSSSSSSSSSSS SSSSSSSSS SSSSSS SS SSSSSS S X
20		09. SSSSSSSSSS S SSSSSSSSSSSSSSSSSSS SSSSSSSSS SSSSSS SS SSSSSS S X
21		10. SSSSSSSSSS S SSSSSSSSSSSSSSSSSSS SSSSSSSSS SSSSSS SS SSSSSS S X
22		11. SSSSSSSSSS S SSSSSSSSSSSSSSSSSSS SSSSSSSSS SSSSSS SS SSSSSS S X
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24		**************(Line 24 Reserved for Operating Systems Information)***********

RCN1 – Reconsideration Review 1

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1	C	MCS RECONSIDERATION REVIEW(RCN1) OR FEDRO REVIEW (FDR1) RCN1 SD3	4
2	0	NH SSSSSSSSS SSSSS SSSSSSSSSS CL SSSSSSSSS SSSSS SSSSSSSSSS
3	l	CROSS REFERENCE SSN: SSSSSSSSS BIC: SS SSN: SSSSSSSSS BIC: SS
4	u	APPELLANT (IF OTHER THAN CLMT OR REP): XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
5	m	ADDRESS: XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXX
6	n	XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXX
7	*	CITY: XXXXXXXXXXXXXXXXXX STATE: XX ZIP: 99999 PHONE: 999 999 9999
8	o	COUNTRY: XXXXXXXXXXXXXXXXXXXXXX CONSUL CODE: 999
9	n	FOREIGN POSTAL ZONE: 999999999999999
10	e	BIC: XX SPOUSE SSN: 999999999 CASE TYPE: 9 1. INITIAL ENT
11		EXPLANATION PROVIDED (Y/N): X RECON REQUESTED (Y/N): X
12	r	SELECT APPEAL CLAIM TYPE: 9 9
13	e	1=RSI RSI 5=SSI BLIND/TITLE II SSBC
14	s	2=DISABILITY WORKER OR CHILD DIWC 6=SSI DISABILITY/TITLE II SSDC
15	e	3=DISABILITY WIDOW(ER) DIWW 7=HEALTH INS ENT HIE
16	r	4=SSI AGED/TITLE II SSAC 8=OTHER XXXXXXXXXXXXXXXXXXXXXXX.
17	v	ISSUE: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
18	e	REASON REQUESTED: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
19	d	XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
20		XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
21		XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
22		ADDITIONAL EVIDENCE (Y/N/F): X
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24		**************(Line 24 Reserved for Operating Systems Information)***********

RCN2 – Reconsideration Request 2

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1	C	MCS RECONSIDERATION REQUEST 2 OR FEDRO REVIEW 2 FDR2 SD3	5
2	0	NH SSSSSSSSS SSSSS SSSSSSSSSS CL SSSSSSSSS SSSSS SSSSSSSSSS
3	l	SELECT SSI APPEAL: 9
4	u	1=CASE REVIEW 2=INFORMAL CONFERENCE 3=FORMAL CONFERENCE.
5	m	IF CLAIMANT REQUESTS OPTION 2 OR 3 UNDER SSI RECON, IS INTERPRETER
6	n	NEEDED (Y/N): X IF YES, SPECIFY LANGUAGE: XXXXXXXXXXXXXXXXXXXXXX
7	*	REPRESENTED (Y/N): X IF NO, LEGAL REFERRAL LIST TO CL (Y/N): X
8	o	ATTORNEY/REP NAME: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX IF YES, ATTY (Y/N): X
9	n	ATTORNEY/REP ADDRESS: XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXX
10	e	XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXX
11		CITY: XXXXXXXXXXXXXXXXXX STATE: XX ZIP: 99999 PHONE: 999 999 9999
12	r	COUNTRY: XXXXXXXXXXXXXXXXXXXXXX CONSUL CODE: 999
13	e	FOREIGN POSTAL ZONE: 999999999999999
14	s	SELECT FILED BY: 9 1=APPELLANT 2=REP. DATE FILED: 99999999
15	e	DETER DATE BEING APPEALED: 99999999 TIMELY REQUEST (Y/N): X
16	r	SELECT IF NO,: 9
17	v	1=CLMT’S EXPLANATION 2=OTHER INFORMATION 3=BOTH 1 AND 2 APPLY.
18	e	EXPLANATION:XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
19	d	XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
20		XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
21		XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
22		DATE SCREEN BEGUN: 99999999
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24		**************(Line 24 Reserved for Operating Systems Information)***********