TN 4 (08-03)
GN 03501.047 Sample Notice
SOCIAL SECURITY ADMINISTRATION
The United States Court of Appeals for the (fill-in) Circuit has made a decision in another case that could possibly affect the decision we made on your prior claim. The name of the case is fill-in. In this case, the court found that (fill-in). We have issued the (fill-in) acquiescence ruling, which is an instruction explaining how we will apply the court decision to claims affected by the court’s decision.
YOU MAY ASK US TO REVIEW YOUR EARLIER CLAIM
You should contact your local Social Security office if you would like us to make a new decision on your claim based on the (fill-in) acquiescence ruling. If you contact us to ask for a review of our earlier decision on your claim, you should provide us with the name of the court case or the name of the Acquiescence Ruling (both noted above). We will also ask you for any other information we need to help us decide whether applying the acquiescence ruling to your claim could change our prior decision.
WHEN WE WILL MAKE A NEW DECISION ON YOUR PRIOR CLAIM
We will make a new decision on your prior claim only if, based on our review of the information about your case, we determine that the (fill-in) acquiescence ruling could change our prior decision.
If you have an attorney or someone else helping you with your claim, you should contact him/her. You should also give him or her a copy of this notice.
IF YOU HAVE ANY QUESTIONS
If you have any questions, you may contact your local Social Security office. If you call or visit a Social Security office, please have this letter with you. It will help us answer your question(s). Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office. We invite you to visit our web site at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll-free at 1-800-772-1213, or call your local office at (fill-in local #). If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office.
SI USTEDHABLA ESPANOL
Si usted habla español y no entiende esta carta, or favor llame o visite su oficina local de Seguro Social. Un representante de la oficina de Seguro Social le explicará esta carta. Debe informarle que usted está respondiendo al aviso, (Fill in name of case).