TN 54 (09-26)
ALS023 INITIAL RECONSIDERATION (G17)
(System
Generated)
Caption: Do You Think We Are Wrong
If you do not agree with this decision, you have the right to appeal. We will review
(1) case and look at any new facts you have. A person who did not make the first decision
will decide (2) case. We will review the parts of the decision that you think are wrong and correct
any mistakes. We may also review the parts of our decision that you think are right.
We will make a decision that may or may not be in (3) favor.
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•
You have 60 days to ask for an appeal.
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•
The 60 days start the 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.
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•
You must have a good reason for waiting more than 60 days to ask for an appeal.
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•
You must ask for an appeal in writing. Please use our Request for Reconsideration
form, SSA-561-U2. You may go to our website at (4) to locate the form. You can also contact us to request the form, or if you need help
filling out the form.
Fill-in values:
Fill-in (1)
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (2)
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (3)
Choice 1: your
Choice 2: his
Choice 3: her
ALS054 REMINDER OF IMPORTANCE TO ATTEND HEARING (G87)
(System
Generated)
Caption: It Is Important That You Go To The Hearing
It is very important that you go to the hearing. If for any reason you can't go, contact
the ALJ as soon as possible before the hearing and explain why. The ALJ will reschedule
the hearing if you have a good reason.
If you don't go to the hearing and don't have a good reason for not going, the ALJ
may dismiss your request for a hearing.
ALS113 FPM CASE-RIGHT TO APPEAL (G82)
(System
Generated)
Caption: If You Disagree With The Decision
If you disagree with the decisions, you have the right to appeal. A person who did
not make the first decision will decide your case. We will review those parts of the
decisions you disagree with and will look at any new facts you have. We may also review
those parts of the case that you believe are correct and may make them unfavorable
or less favorable to you.
ALS123 FPM CASE-EXPLANATION THAT HEARING WILL BE PROCESSED FIRST (G85)
(System
Generated)
Caption: If You Ask For A Reconsideration And A Hearing
If you ask for both a reconsideration and a hearing, we will process the hearing first,
even if you made the reconsideration request first. When we make our decisions, we
will send you letters explaining our decisions on both the reconsideration and the
hearing.
ALS125 FPM CASE-EXPLANATION OF HEARING PROCESS (G86)
(System
Generated)
Caption: How The Hearing Process Works
After we send your case for a hearing, an Administrative Law Judge (ALJ) will mail
you a letter at least 20 days before the hearing to tell you its date, time and place.
The letter will explain the law in your case and tell you what has to be decided.
Since the ALJ will review all the facts in your case, it is important that you give
us any new facts as soon as you can.
The hearing is your chance to tell the ALJ why you disagree with the decisions in
your case. You can give the ALJ new evidence and bring people to testify for you.
The ALJ also can require people to bring important papers to your hearing and give
facts about your case. You can question these people at your hearing.
ALS170 ALJ OR APPEALS COUNCIL DECISION (C13)
(Requested)
Caption: Do You Think We Are Wrong
(1) entitled to benefits because of a decision made (2) .
If you disagree with this decision, you have the right to appeal. We will review your
case and consider any new facts you have. A person who did not make the first decision
will decide (3) case. We will correct any mistakes. We will review those parts of the decision, which
you believe are wrong and will look at any new facts you have. We may also review
those parts, which you believe are correct and may make them unfavorable or less favorable
to (4) .
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•
You have 60 days to ask for an appeal.
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•
The 60 days start the day after you get this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
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•
You will have to have a good reason for waiting more than 60 days to ask for an appeal.
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•
You have to ask for an appeal in writing. We will ask you to sign a form SSA-561-U2,
called Request for Reconsideration. Contact one of our offices if you want help.
Fill-in values:
Fill-in (1) System Generated
Choice 1: You are
Choice 2: Beneficiary's Name is
Fill-in (2) - Requested As A One Position Alpha Character
Choice 1 (A): by the Appeals Council
Choice 2 (B): by the Administrative Law Judge
Choice 3 (C): on your hearing request
Fill-in (3) System Generated
Choice 1: Beneficiary's Name
Choice 2: your
Fill-in (4) System Generated
Choice 1: you
Choice 2: him
Choice 3: her
ALS171 FPM CASE-EXPLANATION OF THE DIFFERENCE BETWEEN A RECONSIDERATION AND A HEARING (G83)
(System
Generated)
Caption: About The Appeals
If you disagree with the non-medical decisions we made on (1) case, the appeal is called a reconsideration. Some examples of non-medical decisions
are the amount of your payment and the month your payment starts. You will not meet
the person who decides (2) case.
If you disagree with the disability (medical) decision made by the state, the appeal
is called a hearing. Some examples of medical decisions are the date your disability
started or whether you are still disabled.
Fill-in values:
Fill-in (1)
Choice 1: your
Choice 2: Beneficiary's name possessive
Fill-in (2)
Choice 1: your
Choice 2: his
Choice 3: her
ALS172 FPM CASE-EXPLANATION OF 60 DAY APPEAL PERIOD (G84)
(System
Generated)
Caption: If You Want To Appeal
(1) 60 days to ask for an appeal.
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•
The 60 days start the day after (2) this letter. We assume (3) got this letter 5 days after the date on it unless (4) us that (5) did not get it within the 5 day period.
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•
(6) must have a good reason if (7) more than 60 days to ask for an appeal.
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•
(8) to ask for an appeal in writing. We will ask (9) to sign a form SSA-561-U2, called Request for Reconsideration or a form HA-501, called
Request for Hearing. Contact one of our local offices if (10) help.
Fill-in values:
Fill-in (1)
Choice 1: You have
Choice 2: Beneficiary name plus has
Fill-in (2)
Choice 1: you receive
Choice 2: he receives
Choice 3: she receives
Fill-in (3)
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (4)
Choice 1: you show
Choice 2: he shows
Choice 3: she shows
Fill-in (5)
Choice 1: you
Choice 2: he
Choice 3: she
Fill-in (6)
Choice 1: You
Choice 2: He
Choice 3: She
Fill-in (7)
Choice 1: you want
Choice 2: he wants
Choice 3: she wants
Fill-in (8)
Choice 1: You have
Choice 2: He has
Choice 3: She has
Fill-in (9)
Choice 1: you
Choice 2: him
Choice 3: her
Fill-in (10)
Choice 1: you want
Choice 2: he wants
Choice 3: she wants
ALS185 DECISION REVISED BASED ON RECONSIDERATION (A11)
(Requested)
Caption: Do You Think We Are Wrong
As you asked, we have reviewed (1) case, and are changing an earlier decision we made. If you think we are wrong, you
have the right to request a hearing. At the hearing, a person who has not seen your
case before will look at it. That person is an Administrative Law Judge. In the rest
of this letter, we will call this person an ALJ. The ALJ will review those parts of
the decision, which you believe are wrong. The ALJ will look at any new facts you
have and correct any mistakes. The ALJ may also review those parts, which you believe
are correct and make them unfavorable or less favorable to (2) .
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•
You have 60 days to ask for a hearing.
-
•
The 60 days start the 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.
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•
You must have a good reason if you wait more than 60 days to ask for a hearing.
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•
You have to ask for a hearing in writing. If you want to make a request, please contact
one of our offices. We can help you complete the required form.
Please read the enclosed pamphlet, Your Right To An Administrative Law Judge Hearing
And Appeals Council Review Of Your Social Security Case. It contains more information
about the hearing.
NOTE: MADCAP suppresses ALS120 if ALS185 is requested. If ALS185 is used in a manual Aurora
notice, DO NOT include ALS120.
Fill-in values:
Fill-in (1) Systems Generated:
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (2) Systems Generated
Choice 1: you
Choice 2: him
Choice 3: her
ALS186 DECISION REVISED BASED ON RECONSIDERATION - POSTENTITLEMENT LETTERS - FOREIGN (A17)
(Requested)
Caption: Do You Think We Are Wrong
We are sending you this letter because we changed an earlier decision we made. We
made this change because you asked us to review (1) case.
If you still think any of our decisions are wrong, you have the right to appeal. A
person who has not seen (2) case before will look at it. That person will be an Administrative Law Judge. The
Administrative Law Judge will correct any mistakes and look at any new facts you have
before deciding (3) case. We call this a hearing.
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•
You have 60 days to ask for a hearing.
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•
The 60 days start the day after you get this letter.
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•
You will have to have a good reason for waiting more than 60 days to ask for a hearing.
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•
You can only have a hearing in the United States. You would have to pay any costs
for traveling to the United States for the hearing. If you cannot come to the hearing,
the Administrative Law Judge will review your case plus any new information you send
us. We will send you a letter about the Administrative Law Judge's decision.
You have to ask for a hearing in writing. Contact us if you want help.
Fill-in values:
Fill-in (1) Systems Generated:
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (2) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (3) Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name possessive
(System
Generated)
Caption: Do You Think We Are Wrong
If you think this information is not correct or you want to report any changes in
(1) work plans or earnings, please get in touch with (2) benefits counselor at Abt Associates. Please call their toll-free number at 1-8777266309
(8777BOND09) to report any changes. If you have a hearing or speech impairment, you
may call their TTY number, 1-877-726-6390 (877-7BOND90).
Fill-in values:
Fill-in (1) Systems Generated
Choice 1: your
Choice 2: Beneficiary's Name possessive
Fill-in (2) Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
ALS193 HEARING PARAGRAPH - FOREIGN-FOR AWARD LETTERS AFTER A FAVORABLE RECONSIDERATION DETERMINATION
(A15)
(Requested)
Caption: Do You Think We Are Wrong
If you think we are wrong, you have the right to request a hearing. At the hearing,
a person who has not seen your case before will look at it. That person is an Administrative
Law Judge. In the rest of our letter, we will call this person an ALJ. The ALJ will
review those parts of the decision which you believe are wrong. The ALJ will look
at any new facts you have and correct any mistakes. The ALJ may also review those
parts which you believe are correct and may make them unfavorable or less favorable
to you.
-
•
You have 60 days to ask for a hearing
-
•
The 60 days start the day after you receive this letter.
-
•
You must have a good reason if you wait more than 60 days to ask for a hearing.
-
•
You can only have a hearing in the United States. You would have to pay any costs
for traveling to the United States for the hearing. If you cannot come to the hearing,
the Administrative Law Judge will review your case plus any new information you send
us. We will send you a letter about the Administrative Law Judge's decision.
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•
You have to ask for a hearing in writing. Contact us if you want help.
Please read the enclosed pamphlet, "Your Right to an Administrative Law Judge Hearing
and Appeals Council Review of Your Social Security Case." It contains more information
about the hearing.
ALS197 HEARING PARAGRAPH FOR AWARD LETTERS AFTER A FAVORABLE RECONSIDERATION DETERMINATION
DOMESTIC (A12)
(Requested)
Caption: Do You Think We Are Wrong
If you think we are wrong, you have the right to request a hearing. At the hearing,
a person who has not seen your case before will look at it. That person is an Administrative
Law Judge. In the rest of our letter, we will call this person an ALJ. The ALJ will
review those parts of the decision which you believe are wrong. The ALJ will look
at any new facts you have and correct any mistakes. The ALJ may also review those
parts which you believe are correct and may make them unfavorable or less favorable
to you.
-
•
You have 60 days to ask for a hearing.
-
•
The 60 days start the day after you receive this letter.
-
•
You must have a good reason if you wait more than 60 days to ask for a hearing.
-
•
You have to ask for a hearing in writing. If you want to make a request, please contact
one of our offices. We can help you complete the required form.
Please read the enclosed pamphlet, Your Right To An Administrative Law Judge Hearing
And Appeals Council Review Of Your Social Security Case. It contains more information
about the hearing.
ALS217 RIGHT TO APPEAL THE OVERPAYMENT
(Systems Generated)
Caption: You Have the Right To Request a Reconsideration
If you do not agree with this determination, you have the right to appeal. Notify
us promptly if you would like to request a reconsideration. We will review the case
and look at any new facts you have. A person who did not make the first decision will
decide the case. If you appeal, we will not collect the overpayment until we notify
you of our appeal determination. We will review the entire determination and correct
any mistakes. We may also review those parts of the case that you believe are correct
and make them unfavorable or less favorable to (1) . We will make a determination that may or may not be in (2) favor.
You have 60 days to ask for an appeal.
-
•
The 60 days start the 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.
-
•
You must have a good reason for waiting more than 60 days to ask for an appeal.
-
•
You must ask for an appeal in writing. Please use our “Request for Reconsideration”
form, SSA-561.
The fastest and easiest way to file an appeal is to visit (3) online. Alternatively, you can complete and submit the "Request for Reconsideration"
form, SSA-561. You may go to our website at (4) to find the form SSA-561. Customers with an online Social Security account can now
submit some documents electronically to us. Create or sign in to your my Social Security
account at (5) and select “Upload Documents.” You can also contact us by phone, mail, or come into
an office to request the form. You may also submit the form by mail or in person to
your local SSA field office. The field office’s mailing address is available through
SSA’s website at (6) . If you need help filling out and submitting the form, we can help you by phone
or in person.
Fill-in values
Fill-in (1) - Systems Generated
Choice 1: you
Choice 2: Beneficiary's Name (not possessive)
Fill-in (2) - Systems Generated
Choice 1: your
Choice 2: his
Choice 3: her
Fill-in (3) - Systems Generated
Fill-in (4) - Systems Generated
Fill-in (5) - Systems Generated
Fill-in (6) - Systems Generated