DI 12095.000 Appeals Processing Exhibits

Subchapter Table of Contents
Section   Latest
Transmittal
DI 12095.001 General
DI 12095.005 SSA-561-U2 (Request for Reconsideration)
DI 12095.010 SSA-561-U2 SP (Solicitud Para Reconsideration) (Request for Reconsideration)
DI 12095.015 SSA-831-C3/U3 (Disability Determination and Transmittal)
DI 12095.020 SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal — Title XVI)
DI 12095.025 SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal — Title II)
DI 12095.030 SSA-3441-BK (Disability Report - Appeal) TN 3 03-15
DI 12095.040 SSA-789-U4 (Request for Reconsideration - Disability Cessation)
DI 12095.050 SSA-773-U4 (Waiver of Right to Appear - Disability Hearing)
DI 12095.055 SSA-769-U4 (Request for Change in Time/Place of Disability Hearing)
DI 12095.065 SSA-770-U4 (Notice Regarding Substitution of Party Upon Death of Claimant - Reconsideration of Disability Cessation)
DI 12095.070 HA-501-U5 (Request for Hearing by Administrative Law Judge)
DI 12095.075 HA-501-U5 SP (Solicitud Para Audiencia) (Request for Hearing)
DI 12095.080 SSA-636 (Transmittal Notice - Hearing Case)
DI 12095.085 HA-4608 (Waiver of Your Right to Personal Appearance Before an Administrative Law Judge)
DI 12095.090 HA-4608 SP (Renuncia al Derecho de Comparecer Ante un Juez de Derecho Administrativo) (Waiver of your right to personal appearance before an Administrative Law Judge)
DI 12095.100 HA 520-U5 (Request for Review of Hearing Decision/Order)
DI 12095.110 Form SSA-1128 (Attorney Representation)
DI 12095.115 Form SSA-1696-U4 (Appointment of Representative)
DI 12095.116 SSA-L1697-U3 (Notice to Representative of Claimant Before the Social Security Administration)
DI 12095.117 SSA-1560-U4 (Petition For Authorization to Charge and Collect a Fee for Services Before the Social Security Administration)
DI 12095.120 HA-539 (Notice Regarding Substitution of Party Upon Death of Claimant)
DI 12095.125 Model Language SSI Notice of Planned Action - DA&A Provisions Apply
DI 12095.130 Model Language SSI Notice of Reconsideration - DA&A Finding Affirmed
DI 12095.135 Model Language SSI Notice of Planned Action - Noncompliance With Treatment Referral
DI 12095.140 Model Language SSI Notice of Planned Action - Individual Does Not Agree With Appropriateness/Availability of Treatment
DI 12095.145 Model Language SSI Notice of Decision - Post Eligibility (PE) Review of Noncompliance Finding Treatment for DA&A Not Appropriate and/or Available - Recipient Still Required to Receive Payments Through a Representative Payee
DI 12095.150 Model Language SSI Notice of Reconsideration - DA&A Recipient Who Is in Noncompliance with Treatment Requirement
DI 12095.155 Model Language SSI Notice of Change - Reinstatement Notice to DAA Recipient Who Was in Noncompliance with Treatment Requirement
DI 12095.160 Model Language SSI Notice of Decision - Attainment of Age 65, Change of Category
DI 12095.165 Model Letters Regarding Benefit/Payment Continuation
DI 12095.170 Benefit/Payment Continuation Requests
DI 12095.171 SSA-795 Election Statement — Exhibits TN 2 10-06
DI 12095.172 Appeals Council Remand of Medical Cessation -- Exhibits TN 2 10-06
DI 12095.180 Model Language – Interim Notice – Reconsideration Reversal of an SGA Cessation When a Medical Issue Exists TN BASIC 11-02

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DI 12095.000 - Appeals Processing Exhibits - Table of Contents - 03/13/2015
Batch run: 03/13/2015
Rev:03/13/2015