Dear [NAME],
On [DATE], the Appeals Council received a request for review of
the Administrative Law Judge's [decision or dismissal] in your case. The
request was submitted by [NAME], and is currently pending with the
Appeals Council.
We are writing to you because it is not clear whether you know that
a request for review was filed in your case. If you want to continue
with the appeal, you do not need to do anything. We will continue
processing the request for review if we do not receive anything in
writing from you. We will not provide any information about your appeal
to the person who submitted the request for review, unless you give us
written permission.
If you want to withdraw the appeal, we need you to tell us in
writing that you understand the following information:
•
If you withdraw your appeal, you may lose benefits or
not qualify for benefits at all.
•
The Administrative Law Judge's decision will be final
and binding.
•
The Appeals Council does not approve all withdrawal
requests, so we may not approve your request.
•
If the Appeals Council approves your withdrawal
request, you will receive a notice dismissing your request for
review.
Please include your social security number on your statement, and
submit the statement to us within 15 days of the date of this letter. If
you do not return a written statement, we will continue processing your
request for review, and you will be notified in writing of the Appeals
Council action in your case.
Our address is:
Social Security Administration
Office of Appellate Operations
6401 Security Blvd
Baltimore, MD 21235-6401
You may also fax this information to us at [FAX NUMBER], Attn:
[Branch **]
If you have any questions about this information, please call us
at 703-605-8000 or Toll Free 1-877-670-2722. Thank you.
Appeals Council, Social Security Administration