SI 04040.020: Requesting Appeals Council Review

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~~Effective Dates: 05/10/2016 - Present~~
Effective Dates: 01/17/2018 - Present
TN 3 (07-12)
SI 04040.020 Requesting Appeals Council Review
A. Appeals council (AC) review policy
The AC considers Administrative Law Judge (ALJ) decisions and orders of dismissal at the request of the claimant or on its own motion. When the AC receives a request to review an ALJ action, the AC may deny or dismiss the request for review, or grant the request and issue a decision or remand the case to the ALJ.
B. The requirements for filing a request for AC review
1. Who has the right to AC review
Any party to an ALJ's decision or order of dismissal has a right to AC review. An individual is considered a party if that individual's rights with respect to monthly benefits, a lump-sum payment, a period of disability, or entitlement to health insurance benefits, may be adversely affected by the decision or order of dismissal.
2. Who may request AC review
The claimant, his or her appointed representative (or representative payee), or other third party on behalf of the claimant can file a request for AC review. The technician must provide a copy of the request for AC review to the claimant as notification that SSA received the appeal.
3. How to request AC review
If a claimant is dissatisfied with an ALJ’s hearing decision, or order of dismissal, the claimant may request AC review of the hearing decision, or order of dismissal. A claimant may specifically ask for a review, or imply that he or she is requesting a review. You may find an implied request for review when a claimant expresses disagreement or dissatisfaction with the ALJ's action, or expresses his or her intent to pursue appeal rights. However, a claimant must make the request (e.g., walk-in, mail, fax, or email) for AC review by submitting to us in writing:
* a completed Form HA-520-U5 (Request for Review of Hearing Decision/Order), or
* a letter, fax, email message, or other written document.
We do not require a signature on the Form HA-520-U5 or any other written request for AC review. For procedures to obtain a written request for AC review, see SI 04040.020C.2. through SI 04040.020C.4.
4. When to request AC review
A claimant must submit a request for AC review to us within 60 days after the date he or she receives the ALJ’s decision or order of dismissal. We presume that the claimant receives the ALJ’s decision, or order of dismissal, within 5 days after the date on the notice, unless there is a reasonable showing to the contrary.
5. Extension of time to request AC review
Only the AC has the authority to extend the time for filing a request for AC review. A claimant may file a request for an extension at the locations listed in SI 04040.020B.6. of this section.
You must complete the following actions if a claimant files a request for AC review after the 60-day period.
* Obtain a written statement that explains the claimant’s reason for late filing of the appeal. The claimant can add a good cause statement to an appeal request, such as the HA-520-U5, or submit as a separate written statement.
* Attach the statement, and any field office (FO) documentation concerning the delay, to the AC copy of the Form HA-520-U5.
* Advise the claimant that the AC will decide whether good cause exists to extend the time for filing a request for review.
6. Where to file a request for AC review
A claimant may submit a request for AC review at any SSA office, the Veterans Administration Regional Office in the Philippines, any Foreign Service Post, or any Railroad Retirement Board (RRB) office (if the claimant has at least 10 years or after December 31, 1995 has at least 5 years of service in the railroad industry).
C. FO procedures for processing a request for AC review
1. Assist the claimant with completing the Form HA-520-U5
If a claimant decides to file a request for AC review, you must complete the following actions.
* Assist the claimant with completing Form HA-520-U5. Complete the form per the instructions in SI 04040.020D.
* Advise the claimant that the AC may deny or dismiss the request for review, or grant the request and issue a decision, or remand the case to the ALJ.
NOTE: For a Disability Request for AC Review, process this request per the instructions in DI 12020.001B.3.
2. Claimant requests AC review during a face-to-face interview
* Use the Modernized Supplemental Security Income Claims System (MSSICS) appeal screens to complete the request for AC review. For instructions on how to complete the MSSICS appeal screens, see MSOM MSSICS 020.001.
* Print the request for AC review.
* Allow the claimant (in office) to review, and if necessary, to correct the request for AC review.
* Save and store the request for AC review in the Online Retrieval System (ORS).
* For non-medical appeals, fax the request for AC review and additional evidence into the Non-disability Repository (NDRED).
* Place the claims folder copy of the request for AC review, and any additional evidence, into the paper folder.
* Distribute the request for AC review per the instructions in SI 04040.020E.
3. Claimant requests AC review by telephone
Send a Form HA-520-U5 to the claimant to complete and return. Stress the importance of returning the completed form timely to establish a written request for appeal. Process the returned form per the instructions in SI 04040.020C.2.
4. Claimant requests AC review in writing to FO
If a claimant submits (walk-in, mail, fax, email) a Form HA-520-U5, a letter, fax message, email message, or other written document, to request AC review, process it per the instructions below and the instructions in SI 04040.020C.2. and SI 04040.020E.
* Document the request for review date as the postmark, date-stamp, fax, or email message date.
* Document that the claimant made the request by letter, fax, email message, or other written document, when the claimant submits the request for review on a document other than the Form HA-520-U5.
* Attach the letter, fax, email message, or other written document to the claims folder copy of the appeal form and a legible copy of it to each remaining copy of the form as detailed in SI 04040.020E. EXCEPTION: If the letter, fax, email message, or other written document is marked “confidential,” do not make the additional copies. The AC determines if the material can be included in the official record.
5. Claimant withdraws request for AC review
The AC may dismiss a request for review at the claimant’s request. If the claimant indicates that he or she wishes to withdraw the request for AC review, take the following actions, and advise the claimant that the AC will notify him or her of the AC’s action on the withdrawal request.
* Obtain a statement from the claimant that includes the following information:
* claimant’s name, address and social security number,
* a statement of why the claimant wishes to withdraw the AC request, and
* the claimant’s statement that he or she fully understands that the ALJ hearing decision will be final and binding.
* Prepare 4 copies (5 if there is a representative) of the withdrawal request and distribute it in the same manner as Form HA-520-U5. For distribution instructions, see SI 04040.020E.
NOTE: A signature is not required on the written request for withdrawing a request for AC review.
6. Claimant requests status on pending case
To respond to status inquiries, FO and National 800 Number Network staff should take one of the actions listed below. NETSTAT lists the processing timeframes.
* If processing timeframes have not expired, query the Appeals Review Processing System to obtain the status of a pending case.
* If processing timeframes have expired, request a status update from Office of Disability Adjudication and Review (ODAR). Offices should direct status inquires to ODAR, Congressional and Public Affairs Branch at (703) 605-8000 or by fax at (703) 605-8021.
* If processing timeframes have expired, request a status update from Office of Disability Analytics, Review, and Oversight (OARO). Offices should direct status inquires to OARO, Congressional and Public Affairs Branch at (703) 605-8000 or by fax at (703) 605-8021.
7. Claimant threatens suicide, homicide, or other violent acts
When a claimant threatens suicide or homicide, follow the High Risk Alert procedures at the Visitor Intake Process website. Annotate the file to indicate that the claimant may be a danger to self, or others. For disability claims, also see Handling Potential Suicidal-Homicidal Behavior in DI 11005.080. N8NN agents should follow the procedures for Crisis Instructions for 800 Number Agents in TC 13001.010.
8. Claimant complains of alleged ALJ bias or misconduct
If the claimant alleges ALJ bias or misconduct, follow the procedure described in Complaints of Alleged Bias or Misconduct by ALJs in GN 03103.300 (for FOs) and in TC 03001.030 (for N8NN agents).
D. Instructions for completing the Form HA-520-U5
When possible, complete the request for AC review in MSSICS per the instructions in MSOM MSSICS 020.001 and SI 04040.020B.2.
1. Claimant’s (spouse’s) name and social security number (SSN) - number 1
* Enter the claimant’s name and SSN.
* Enter the claimant’s spouse’s name and SSN whenever the claimant and his or her spouse are living together, regardless of whether the spouse is eligible, or is a party (see note below) to the appeal. Also, enter the spouse’s information for a case in which the claimant and his or her spouse are not living together and the issue the claimant is appealing is his or her marital relationship.
NOTE: If the claimant and the spouse are filing a request for AC review, have both parties complete the same Form HA-520-U5, if possible. Otherwise, have each person complete a separate form.
2. Reason for appeal - number 4
Enter the reason(s) the claimant disagrees with the ALJ’s action. If the claimant needs additional space, he or she may use a separate sheet of paper and attach a copy to each copy of the Form HA-520-U5.
3. Claimant’s and appointed representative’s information - number 5 and 6
* Enter the claimant’s address, telephone number, and fax number.
* If the claimant has an appointed representative, enter the representative’s name, address, telephone number, and fax number. Obtain an SSA-1696-U4 (Appointment of Representative) if the claimant or representative has not previously filed one with us. For information about appointment of a representative, see GN 03910.040.
* We do not require a signature to file an appeal. Therefore, the claimant and representative are not required to sign the form.
4. Acknowledge the request for AC review - number 7
The employee who prepares, or receives, the form must complete the box marked for SSA. If an office other than the servicing FO completes it, annotate the FO code with a brief explanation.
* Show the earliest of the following dates as the date filed:
* date of in-office filing, or
* postmark or date-stamp on the Form HA-520-U5, or
* postmark or date-stamp on the letter, or any other written document, or the date on the fax or email message that requests or indicates intent to file a request for AC review.
* Enter the servicing FO code.
* Attach any letter, or other written document, that appears to be a request for AC review, or expresses dissatisfaction with the ALJ action, to the claims folder copy of the Form HA-520-U5.
* Attach the postmarked envelope to the claims folder copy of the Form HA-520-U5 if you use the postmark to establish the date of filing.
5. Timeliness of request for AC review - numbers 8 and 9
Check the appropriate block to indicate whether we received the request for AC review within 65 days of the ALJ’s decision or dismissal. In concurrent claims (title II and title XVI), check “yes” only if the request on both claims is timely. Check “no” when the request on one claim, or both claims, is not timely, and specify which one(s) is not.
If you check “no”, obtain a statement that explains the claimant’s reason for late filing and develop for good cause. The statement should include the following information:
* claimant’s name and address, and
* reason for the delay.
Forward the statement, any development, and the claim’s folder copy of the Form HA-520-U5, to the AC. The AC will determine whether the request is timely and whether the claimant has good cause.
6. Type of action - number 10
Check whether the request for AC review is intended for initial entitlement, termination, or other.
7. Type of claim - number 11
Check all claim types that apply. If the request for review involves an issue not relating to a claim type (i.e., waiver of overpayment, dismissal of ALJ hearing request, etc.), specify the reason next to “Other.”
NOTE: Make only one entry in this section.
8. Additional evidence
The claimant should submit any document(s), or other evidence, that he or she wants the AC to consider with AC review. For information on how the AC handles additional evidence, see HALLEX I-3-5-20.
* Submit the claimant’s additional evidence as follows:
* Attach any evidence to the “claims folder” copy of the Form HA-520-U5.
* Annotate “evidence attached” on each copy of the Form HA-520-U5.
* Annotate the claimant's name and SSN on any evidence that the claimant sends to the FO.
* If the claimant is unable to submit the additional evidence at the time he or she files the request for AC review, advise the claimant to forward any additional evidence, marked with his or her name and SSN, within 15 days to the address listed in SI 04040.020E.
* Describe briefly, in the “Reasons for Disagreement” section, the type of evidence the claimant will submit.
* If the claimant submits evidence after filing the request for AC review, annotate the evidence with claimant’s name and SSN, and forward it directly to the Office of Appellate Operations at the address listed in SI 04040.020E.1.
* Do not delay forwarding the request for AC review pending submission of evidence.
b. If the claimant's statement, or other information, indicates any development leads which might permit a favorable decision, record the information on an SSA-5002 (Report of Contact) and attach a copy of it to each copy of the Form HA-520-U5, except for the claimant’s copy.
E. Distribute copies of the completed Form HA-520-U5
Distribute copies of the completed Form HA-520-U5 immediately. Do not delay distribution of the form pending submission of additional evidence. Distribute as follows:
* Claims folder copy
Send the claims folder copy of the Form HA-520-U5 and any available additional evidence to ODAR within 1 business day of the date it is filed to the following address (see Note). ODAR, Office of Appellate Operations 5107 Leesburg Pike Falls Church, VA 22041-3255
Send the claims folder copy of the Form HA-520-U5 and any available additional evidence to OARO within 1 business day of the date it is filed to the following address (see Note). OARO, Office of Appellate Operations 5107 Leesburg Pike Falls Church, VA 22041-3255
NOTE: For a Disability request for AC Review, process the request per the instructions in DI 12020.001B.3.
* Claimant copy
Give or mail the form to the claimant.
* Representative copy
Give or mail the form to the claimant's appointed representative. If the claimant is not represented, destroy this copy.
* Servicing FO copy
Destroy this copy of the form.
* Hearing office file copy
Send a copy of the form to the ALJ who conducted the hearing. Destroy this copy if there is a legible copy of the request for AC review in the certified electronic folder (disability appeals) and NDRED (non-disability appeals).
F. Instructions documenting MSSICS and the Modernized Development Worksheet (MDW)
For MSSICS exclusions, do the following:
* Record the date that we receive the Form HA-520-U5 on the MDW.
* Record all subsequent actions, including all contacts with the claimant, or the claimant’s appointed representative, in either MSSICS or on MDW.
* Post the AC disposition and date in MSSICS or on the MDW.
G. Exhibit – Form HA-520-U5 (Request for Review of Hearing Decision/Order)
To view an exhibit of the Form HA-520-U5, see OS 15070.052.
H. Exhibit – Form HA-520-U5-SP (Request for Review of Hearing Decision/Order – Spanish Version)
To view an exhibit of the Form HA-520-U5-SP, see OS 15070.053.
I. References
* GN 03104.000 AC Review (Title II and Entitlement Under Title XVIII)
* DI 12020.001 Appeals Council (AC) Review
* DI 12030.000 ALJ Hearings
* 20 CFR 416.1466 through 20 CFR 416.1484 Appeals Council Review
* SI 04005.015 Good Cause for Extending Time Limit

POMS Reference

SI 04040.020: Requesting Appeals Council Review