Include the following when preparing the SSA-662 or an equivalent:

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  statement of jurisdictional factors — filing of application, date of notice of initial determination, date of request for reconsideration;

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  basis of request for reconsideration;

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  statement of issues;

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  brief nontechnical statement of the applicable provisions of the law and regulation;

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  statement of the facts and evidence as presented;

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  findings of fact;

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  conclusions based on findings of fact and applicable law and regulations.

To view this form, go to SSA-662.