TN 5 (07-12)
GN 03104.100 Requesting Appeals Council Review
A. Appeals council (AC) review policy
The AC considers administrative law judge (ALJ) decisions and orders of dismissal at the request of the claimant or on its own motion. When the AC receives a request to review an ALJ action, the AC may deny or dismiss the request for review, or grant the request and issue a decision or remand the case to the ALJ.
The AC reviews Medicare Qualified Government Employee (MQGE) Disability appeals.
NOTE: Elimination of the request for AC review for disability claims is applicable per the Disability Redesign Prototype operating instructions available on the Philadelphia Regional Office Website.
B. The requirements for filing a request for AC review
1. Who has the right to AC review
Any party to an ALJ's decision or order of dismissal has a right to AC review. An individual is considered a party if that individual's rights with respect to monthly benefits, a lump sum payment, a period of disability, or entitlement to health insurance benefits may be adversely affected by the decision or order of dismissal.
2. Who may request AC review
The claimant, his or her appointed representative (or representative payee), or other third party on behalf of the claimant, can file a request for AC review. The technician must provide a copy of the request for AC review to the claimant as notification that we received the appeal.
3. How to request AC review
If a claimant is dissatisfied with an ALJ's hearing decision or order of dismissal, the claimant may request the AC to review the hearing decision or order of dismissal. A claimant may specifically ask for a review or may imply that he or she is requesting review. You may find an implied request for review when a claimant expresses disagreement or dissatisfaction with the ALJ's action or expresses his or her intent to pursue appeal rights. However, a claimant must make the request for AC review to us in writing (e.g., walk-in, mail, fax, or email) by submitting:
a completed Form HA-520-U5 (Request for Review of Hearing Decision/Order), or
a letter, fax message, email message, or other written document, that requests review of the hearing decision or order of dismissal.
We do not require a signature on the Form HA-520-U5 or any other written request for AC review. For procedures for obtaining a written request for AC review, see GN 03104.100C.2. through GN 03104.100C.4.
4. When to request AC review
A claimant must submit a request for AC review to us within 60 days after the date he or she receives the ALJ’s decision or order of dismissal. We presume that the claimant receives the ALJ’s decision or order of dismissal within 5 days after the date on the notice, unless there is a reasonable showing to the contrary.
5. Extension of time to request AC review
Only the AC has the authority to extend the time for filing a request for AC review. A claimant may file a request for an extension at the locations listed in GN 03104.100C.5. of this section.
You must complete the following actions if a claimant files a request for AC review after the 60-day period.
Per the instructions in GN 03101.020D.2, obtain a written statement that explains the reason for the delay.
Attach the statement, and any field office (FO) documentation concerning the delay, to the AC copy of the Form HA-520-U5.
Advise the claimant that the AC will decide whether good cause exists to extend the time for filing a request for review.
6. Where to file a request for AC review
A claimant may submit a request for AC review at any SSA office, the Veterans Administration Regional Office in the Philippines, any Foreign Service Post, or any Railroad Retirement Board (RRB) office (if the claimant has at least 10 years or after December 31, 1995 has at least 5 years of service in the railroad industry).
C. Procedures for processing a request for AC review
1. Assist the claimant with completing the HA-520-U5
If a claimant decides to file a request for AC review, you must complete the following actions:
Assist the claimant with completing Form HA-520-U5. Complete the form per the instructions in GN 03104.200.
Advise the claimant that the AC may deny or dismiss the request for review, or grant the request and issue a decision or remand the case to the ALJ.
Advise the claimant that he or she must submit any evidence, or other documents, with the request for AC review.
2. Claimant requests AC review during a face-to-face interview
Complete, process, and distribute the Form HA-520-U5 per the instructions in GN 03104.200D.
3. Claimant telephones and requests AC review
Send a Form HA-520-U5 to the claimant to complete and return. Stress the importance of returning the form timely to establish a written request for appeal. Process the returned form per the instructions in GN 03104.200.
4. Claimant writes to the FO or Processing Center (PC) to request an AC review
a. FO procedures for processing a written request for AC review
If a claimant submits (walk-in, mail, fax, email) a Form HA-520-U5, a letter, fax, email message, or other written document to request AC review, complete the Form HA-520-U5 and process it per the instructions in GN 03104.200.
Document the request for review date as the postmark, date-stamp, fax, or email message date.
Document that the claimant made the request by letter, fax message, email message, or other written document, when the claimant submits the request for review on a document other than the Form HA-520-U5.
Attach the letter, fax, email message, or other written document, to the claims folder copy of the appeal form and a legible copy of it to each remaining copy of the form as detailed in GN 03104.200.
EXCEPTION: If the letter, fax, email message, or other written document, is marked “confidential,” do not make the additional copies. The AC determines if the material can be included in the official record.
b. PC procedures processing a written request for AC review
If the claimant submits a request for AC review to the PC, process it per the instructions in GN 03104.100C.4.a. of this section, GN 03104.200, and the instructions below.
If the folder is already at the Office of Appellate Operations (OAO), forward the claims folder copy of Form HA-520-U5 to OAO within 1 business day of the date that the claimant submits the request for AC review to the address listed below.
If the folder is in the PC or FO, obtain the folder and forward it along with the claims folder copy of the Form HA-520-U5 to OAO within 1 business day of the date that the claimant submits the request for AC review to the address listed below:
Office of Analytics Review and Oversight (OARO), Office of Appellate Operations
5107 Leesburg Pike
Falls, Church, VA 22041-3255
NOTE: A signature is not required on the written request for AC review.
5. Forward the Form HA-520-U5 to the AC
Send the claims folder copy of the Form HA-520-U5 along with any available additional evidence to OARO within 1 business day of the date it is filed to the following address.
OARO, Office of Appellate Operations
5107 Leesburg Pike
Falls Church, VA 22041-3255
6. Claimant withdraws request for AC review
The AC may dismiss a request for review at the claimant’s request. If the claimant indicates that he or she wishes to withdraw the request for AC review, take the following actions and advise the claimant that the AC will notify him or her of the AC’s action on the withdrawal request.
Obtain a statement from the claimant that includes the following information:
claimant’s name, address, social security number, and
a statement of why the claimant wishes to withdraw the request for AC review, and
the claimant’s statement that he or she fully understands that the ALJ hearing decision will be final and binding.
Prepare 4 copies (5 if there is a representative) of the withdrawal request and distribute it in the same manner as Form HA-520-U5. For distribution instructions, see GN 03104.200.
7. Claimant requests status on pending case
To respond to status inquiries, FO staff and National 800 Number Network (N8NN) staff, take one of the actions listed below. NETSTAT lists the processing timeframes.
If processing timeframes have not expired, query Appeals Review Processing System to obtain the status of a pending case.
If processing timeframes have expired, request a status update from OARO. Offices should direct status inquires to OARO, Congressional and Public Affairs Branch, at (703) 605-8000, or by fax at (703) 605-8021.
8. Claimant threatens suicide, homicide or other violent acts
When a claimant threatens suicide or homicide, follow the High Risk Alert procedures at the Visitor Intake Process website. Annotate the file to indicate that the claimant may be a danger to self or others. For disability claims, also see Handling Potential Suicidal-Homicidal Behavior in DI 11005.080. N8NN agents should follow the procedures for Crisis Instructions for 800 Number Agents in TC 13001.010.
9. Claimant complains of alleged ALJ bias or misconduct
If the claimant complains of alleged ALJ bias or misconduct, follow the procedure, Complaints of Alleged Bias or Misconduct by ALJs described in GN 03103.300.