DI 12095.000 Appeals Processing Exhibits

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

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http://policy.ssa.gov/poms.nsf/lnx/0412095000
DI 12095.000 - Appeals Processing Exhibits - Table of Contents - 03/13/2015
Batch run: 12/13/2017
Rev:03/13/2015