BASIC (05-11)

NL 00720.040 ALS Appeals

ALS023 INITIAL RECONSIDERATION (G17)

(System Generated)

Caption: Do You Think We Are Wrong

If you do not agree with this decision, you have the right to appeal. We will review  (1)  case and look at any new facts you have. A person who did not make the first decision will decide  (2)  case. We will review the parts of the decision that you think are wrong and correct any mistakes. We may also review the parts of our decision that you think are right. We will make a decision that may or may not be in  (3)  favor.

  • You have 60 days to ask for an appeal.

  • The 60 days start the day after you receive this letter. We assume you received this letter 5 days after the date on it unless you show us that you did not receive it within the 5-day period.

  • You must have a good reason if you wait more than 60 days to ask for an appeal.

  • You can file an appeal with any Social Security office. You must ask for an appeal in writing. Please use our “Request for Reconsideration” form, SSA-561-U2. You may go to our website at  (4)  to find the form. You can also call, write, or visit us to request the form. If you need help to fill out the form, we can help you by phone or in person.

Fill-in values:

Fill-in (1)

Choice 1: your

Choice 2: Beneficiary's Name possessive

Fill-in (2)

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (3)

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (4)

www.socialsecurity.gov/online/

ALS054 REMINDER OF IMPORTANCE TO ATTEND HEARING (G87)

(System Generated)

Caption: It Is Important That You Go To The Hearing

It is very important that you go to the hearing. If for any reason you can't go, contact the ALJ as soon as possible before the hearing and explain why. The ALJ will reschedule the hearing if you have a good reason.

If you don't go to the hearing and don't have a good reason for not going, the ALJ may dismiss your request for a hearing.

Fill-in values:

NONE

ALS113 FPM CASE-RIGHT TO APPEAL (G82)

(System Generated)

Caption: If You Disagree With The Decision

If you disagree with the decisions, you have the right to appeal. A person who did not make the first decision will decide your case. We will review those parts of the decisions you disagree with and will look at any new facts you have. We may also review those parts of the case that you believe are correct and may make them unfavorable or less favorable to you.

Fill-in values:

NONE

ALS123 FPM CASE-EXPLANATION THAT HEARING WILL BE PROCESSED FIRST (G85)

(System Generated)

Caption: If You Ask For A Reconsideration And A Hearing

If you ask for both a reconsideration and a hearing, we will process the hearing first, even if you made the reconsideration request first. When we make our decisions, we will send you letters explaining our decisions on both the reconsideration and the hearing.

Fill-in values:

NONE

ALS125 FPM CASE-EXPLANATION OF HEARING PROCESS (G86)

(System Generated)

Caption: How The Hearing Process Works

After we send your case for a hearing, an Administrative Law Judge (ALJ) will mail you a letter at least 20 days before the hearing to tell you its date, time and place. The letter will explain the law in your case and tell you what has to be decided. Since the ALJ will review all the facts in your case, it is important that you give us any new facts as soon as you can.

The hearing is your chance to tell the ALJ why you disagree with the decisions in your case. You can give the ALJ new evidence and bring people to testify for you. The ALJ also can require people to bring important papers to your hearing and give facts about your case. You can question these people at your hearing.

Fill-in values:

NONE

ALS170 ALJ OR APPEALS COUNCIL DECISION (C13)

(Requested)

Caption: Do You Think We Are Wrong

 (1)  entitled to benefits because of a decision made  (2)  .

If you disagree with this decision, you have the right to appeal. We will review your case and consider any new facts you have. A person who did not make the first decision will decide  (3)  case. We will correct any mistakes. We will review those parts of the decision, which you believe are wrong and will look at any new facts you have. We may also review those parts, which you believe are correct and may make them unfavorable or less favorable to  (4)  .

  • You have 60 days to ask for an appeal.

  • The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You will have to have a good reason for waiting more than 60 days to ask for an appeal.

  • You have to ask for an appeal in writing. We will ask you to sign a form SSA-561-U2, called “Request for Reconsideration.” Contact one of our offices if you want help.

Fill-in values:

Fill-in (1) – System Generated

Choice 1: You are

Choice 2: Beneficiary's Name is

Fill-in (2) - Requested As A One Position Alpha Character

Choice 1 (A): by the Appeals Council

Choice 2 (B): by the Administrative Law Judge

Choice 3 (C): on your hearing request

Fill-in (3) – System Generated

Choice 1: Beneficiary's Name

Choice 2: your

Fill-in (4) – System Generated

Choice 1: you

Choice 2: him

Choice 3: her

ALS171 FPM CASE-EXPLANATION OF THE DIFFERENCE BETWEEN A RECONSIDERATION AND A HEARING (G83)

(System Generated)

Caption: About The Appeals

If you disagree with the non-medical decisions we made on  (1)  case, the appeal is called a reconsideration. Some examples of non-medical decisions are the amount of your payment and the month your payment starts. You will not meet the person who decides  (2)  case.

If you disagree with the disability (medical) decision made by the state, the appeal is called a hearing. Some examples of medical decisions are the date your disability started or whether you are still disabled.

Fill-in values:

Fill-in (1)

Choice 1: your

Choice 2: Beneficiary's name possessive

Fill-in (2)

Choice 1: your

Choice 2: his

Choice 3: her

ALS172 FPM CASE-EXPLANATION OF 60 DAY APPEAL PERIOD (G84)

(System Generated)

Caption: If You Want To Appeal

 (1)  60 days to ask for an appeal.

  • The 60 days start the day after  (2)  this letter. We assume  (3)  got this letter 5 days after the date on it unless  (4)  us that  (5)  did not get it within the 5 day period.

  •  (6)  must have a good reason if  (7)  more than 60 days to ask for an appeal.

  •  (8)  to ask for an appeal in writing. We will ask  (9)  to sign a form SSA-561-U2, called “Request for Reconsideration” or a form HA-501, called “Request for Hearing.” Contact one of our local offices if  (10)  help.

Fill-in values:

Fill-in (1)

Choice 1: You have

Choice 2: Beneficiary name plus has

Fill-in (2)

Choice 1: you receive

Choice 2: he receives

Choice 3: she receives

Fill-in (3)

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (4)

Choice 1: you show

Choice 2: he shows

Choice 3: she shows

Fill-in (5)

Choice 1: you

Choice 2: he

Choice 3: she

Fill-in (6)

Choice 1: You

Choice 2: He

Choice 3: She

Fill-in (7)

Choice 1: you want

Choice 2: he wants

Choice 3: she wants

Fill-in (8)

Choice 1: You have

Choice 2: He has

Choice 3: She has

Fill-in (9)

Choice 1: you

Choice 2: him

Choice 3: her

Fill-in (10)

Choice 1: you want

Choice 2: he wants

Choice 3: she wants

ALS185 DECISION REVISED BASED ON RECONSIDERATION (A11)

(Requested)

Caption: Do You Think We Are Wrong

As you asked, we have reviewed  (1)  case, and are changing an earlier decision we made. If you think we are wrong, you have the right to request a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge. In the rest of this letter, we will call this person an ALJ. The ALJ will review those parts of the decision, which you believe are wrong. The ALJ will look at any new facts you have and correct any mistakes. The ALJ may also review those parts, which you believe are correct and make them unfavorable or less favorable to  (2)  .

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you receive this letter. We assume you received this letter 5 days after the date on it unless you show us that you did not receive it within the 5-day period.

  • You must have a good reason if you wait more than 60 days to ask for a hearing.

  • You have to ask for a hearing in writing. If you want to make a request, please contact one of our offices. We can help you complete the required form.

Please read the enclosed pamphlet, “Your Right To An Administrative Law Judge Hearing And Appeals Council Review Of Your Social Security Case”. It contains more information about the hearing.

NOTE: MADCAP suppresses ALS120 if ALS185 is requested. If ALS185 is used in a manual Aurora notice, DO NOT include ALS120.

Fill-in values:

Fill-in (1) Systems Generated:

Choice 1: your

Choice 2: Beneficiary's Name possessive

Fill-in (2) Systems Generated

Choice 1: you

Choice 2: him

Choice 3: her

ALS186 DECISION REVISED BASED ON RECONSIDERATION - POSTENTITLEMENT LETTERS - FOREIGN (A17)

(Requested)

Caption: Do You Think We Are Wrong

We are sending you this letter because we changed an earlier decision we made. We made this change because you asked us to review  (1)  case.

If you still think any of our decisions are wrong, you have the right to appeal. A person who has not seen  (2)  case before will look at it. That person will be an Administrative Law Judge. The Administrative Law Judge will correct any mistakes and look at any new facts you have before deciding  (3)  case. We call this a hearing.

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you get this letter.

  • You will have to have a good reason for waiting more than 60 days to ask for a hearing.

  • You can only have a hearing in the United States. You would have to pay any costs for traveling to the United States for the hearing. If you cannot come to the hearing, the Administrative Law Judge will review your case plus any new information you send us. We will send you a letter about the Administrative Law Judge's decision.

You have to ask for a hearing in writing. Contact us if you want help.

Fill-in values:

Fill-in (1) Systems Generated:

Choice 1: your

Choice 2: Beneficiary's Name possessive

Fill-in (2) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

Fill-in (3) Systems Generated

Choice 1: your

Choice 2: Beneficiary's Name possessive

ALS190 (WB5) BOND

(System Generated)

Caption: Do You Think We Are Wrong

If you think this information is not correct or you want to report any changes in  (1)  work plans or earnings, please get in touch with  (2)  benefits counselor at Abt Associates. Please call their toll-free number at 1-877–726–6309 (877–7BOND09) to report any changes. If you have a hearing or speech impairment, you may call their TTY number, 1-877-726-6390 (877-7BOND90).

Fill-in values:

Fill-in (1) Systems Generated

Choice 1: your

Choice 2: Beneficiary's Name possessive

Fill-in (2) Systems Generated

Choice 1: your

Choice 2: his

Choice 3: her

ALS193 HEARING PARAGRAPH - FOREIGN-FOR AWARD LETTERS AFTER A FAVORABLE RECONSIDERATION DETERMINATION (A15)

(Requested)

Caption: Do You Think We Are Wrong

 If you think we are wrong, you have the right to request a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge. In the rest of our letter, we will call this person an ALJ. The ALJ will review those parts of the decision which you believe are wrong. The ALJ will look at any new facts you have and correct any mistakes. The ALJ may also review those parts which you believe are correct and may make them unfavorable or less favorable to you.

  • You have 60 days to ask for a hearing

  • The 60 days start the day after you receive this letter.

  • You must have a good reason if you wait more than 60 days to ask for a hearing.

  • You can only have a hearing in the United States. You would have to pay any costs for traveling to the United States for the hearing. If you cannot come to the hearing, the Administrative Law Judge will review your case plus any new information you send us. We will send you a letter about the Administrative Law Judge's decision.

  • You have to ask for a hearing in writing. Contact us if you want help.

 Please read the enclosed pamphlet, "Your Right to an Administrative Law Judge Hearing and Appeals Council Review of Your Social Security Case." It contains more information about the hearing.

ALS197 HEARING PARAGRAPH FOR AWARD LETTERS AFTER A FAVORABLE RECONSIDERATION DETERMINATION — DOMESTIC (A12)

(Requested)

Caption: Do You Think We Are Wrong

If you think we are wrong, you have the right to request a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge. In the rest of our letter, we will call this person an ALJ. The ALJ will review those parts of the decision which you believe are wrong. The ALJ will look at any new facts you have and correct any mistakes. The ALJ may also review those parts which you believe are correct and may make them unfavorable or less favorable to you.

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you receive this letter.

  • You must have a good reason if you wait more than 60 days to ask for a hearing.

  • You have to ask for a hearing in writing. If you want to make a request, please contact one of our offices. We can help you complete the required form.

Please read the enclosed pamphlet, “Your Right To An Administrative Law Judge Hearing And Appeals Council Review Of Your Social Security Case”. It contains more information about the hearing.

Fill-in values:

NONE


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900720040
NL 00720.040 - ALS Appeals - 08/14/2014
Batch run: 08/14/2014
Rev:08/14/2014