TN 3 (12-03)

GN 03105.070 FO Folder Retrieval Checklist — Exhibit

Identifying data (complete all applicable items):

  1. N/H Name:                    SSN:                 

  2. Appellant Name (if different):                          

  3. Cross reference SSN/BOAN (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

    ( ) T2 DI B

    • ( )current folder ( ) prior folder

    ( ) DWB

    ( ) RSI

  8. ( ) Other       

    Query Information(show pertinent information and attach copies):

    1. PCACS date:                shows:                

    2. SSI2 date:                shows:                

    3. HA04 date:                shows:                

    4. Other type:                 date:          shows:                

    Field Office Actions

    1. Component contacted:                

    2. Date of initial request:                

    3. Date of followup request:                

    4. Office making referral:                

    5. Office contact person:                

    6. Office telephone number:                

    7. Date referred to ORC:                


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203105070
GN 03105.070 - FO Folder Retrieval Checklist -- Exhibit - 05/15/2006
Batch run: 01/27/2009
Rev:05/15/2006