GN BOS03103.999 Exhibits

Exhibit 1:

Hearing Request Feedback & Transmittal Form

Exhibit 2:

Folder Retrieval Checklist

A. EXHIBIT 1 — Hearing Request Feedback And Transmittal Form Region I

FROM: ____________________________, Hearing Office Manager
SUBJECT: Request for Hearing
 Claimant:______________________ SSN:_______________
TO: _________________________Social Security Office
      ATTN: District Manager
A request for hearing (copy attached) was received in this office
on ________________. This memo is being forwarded to you for
your information and/or necessary action.
( ) The "Acknowledgment of Request for Hearing" section was
 not completed.
( ) Type of claim was not indicated.
( ) The claimant stated on the request for hearing that
 he/she does not wish to appear for an oral hearing, and
 Form HA-4608, Waiver of Rights to Oral Hearings, was
 not obtained. (Non-MCS cases only. The SG-HA-501
 contains appropriate waiver language). Please advise
 the claimant of his/her rights to an oral hearing and
 its advantages. If the claimant desires to waive the
 right to an oral hearing, please secure a completed
 Form HA-4608. If the claimant wished to appear at a
 hearing, please notify this office immediately.
( ) Request for Hearing was not timely filed. Please
 obtain explanation for late filing.
( ) Request for Hearing received from representative. 
 Please forward TII/TXVI/PE folder.
( ) Other ________________________________________________
Thank you for your attention to this matter. Upon completion of
your actions, please reverse the "TO" and "FROM" designations
above, and use this form to route your development back to ODAR. 
If you need further clarification, please do not hesitate to
contact me at ______________________.
cc: ORCALJ, Boston

B. Exhibit — Folder Retrieval Checklist

I. IDENTIFYING DATA (complete all applicable items)
1. W/E Name:____________________________ SSN:________________
2. Appellant Name (if different):_______________________________
3. Cross reference SSN (if any):________________________________
4. Type of Case (circle one): Hearing AC Review Civil Action
5. Hearing Request Date:______________________
6. Date HA-501 (HO copy) forwarded to ODAR:_________________
7. Type of Folder(s) Needed (check all applicable):
( ) SSI Aged
( ) SSI Blind/Disabled
( ) current folder ( ) prior folder
( ) DI
( ) current folder ( ) prior folder
( ) DWB
( ) RSI
( ) Other (specify):
8. Hearing Office:_______________________
II. QUERY INFORMATION (show pertinent information for all
follow-ups; attach copies if necessary).
1. PCACS date:_____________ shows:_____________________________
2. MBR date:_______________ shows:_____________________________
3. SSI2/SSID date:_________ shows:_____________________________
4. HA04 date:______________ shows:_____________________________
5. DDSQ date:______________ shows:_____________________________


6. Other type:_____________ date:__________ shows:_____________
1. Date of initial request:__________________________
a. Component contacted:_________________________
b. Person contacted (if telephone call):____________________
2. Date of 1st follow-up:_____________________________
3. Date of 2nd follow-up:_____________________________
4. Date escalated to FO Management:________________________
5. Date of manager-to-manager call:__________________
6. Other follow-ups (specify dates/person contacted):
7. Date reconstruction ordered:______________________
8. Date ODAR notified of reconstruction:______________

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GN BOS03103.999 - Exhibits - 05/15/2006
Batch run: 01/27/2009