DI 525: Court Cases
TN 2 (04-99)
Exhibit 1 - Goodnight Potential Class Member Notice
Exhibit 2 - Goodnight Reply Form
Exhibit 3 - Goodnight Court Case Flag/Alert
Exhibit 4 - Court Case Folder Retrieval Worksheet
Exhibit 5 - Unfavorable Decision on Goodnight Class Membership Notice
Exhibit 6 - Goodnight Good Cause Denial Notice
Exhibit 7 - Goodnight SSN Verification Notice
Exhibit 8 - Goodnight Screening Sheet and Instructions
Exhibit 1- Goodnight Potential Class Member Notice
SOCIAL SECURITY ADMINISTRATION
Important Information
DATE: | |
CLAIM NUMBER: | |
DOC: | |
FO ADDRESS: | |
Telephone: |
READ CAREFULLY - PLEASE RESPOND TO THIS NOTICE WITHIN 90 DAYS
We are writing to let you know about a court case called Goodnight v. Apfel. This court case involves certain claims denied by the Utah Disability Determination Services during the period January 1, 1991, through February 20, 1994. Because of this case, you may ask us to review our earlier denial of your disability claim.
WHAT YOU NEED TO DO
You can ask us to look at your claim again. If you want us to do so, please fill out the enclosed reply form and send it to us within 90 days from the day you receive this notice. If you do not return the reply form, we may not be able to review your claim again.
IF YOU NOW GET MONEY FROM SOCIAL SECURITY
Even if you now get money from Social Security, we may owe you still more. If you request review, this will not affect any benefits you may currently be receiving. Return the reply form within 90 days from the day you receive this notice to ask us to review your earlier claim.
IF YOU HAVE ANY QUESTIONS
If you have any questions, you may contact your local Social Security office. The address and telephone number are printed at the top of this notice. If you call or visit a Social Security office, please have this notice with you. It will help us answer your question(s). You may also call us toll free at 1-800-772-1213 if you have any questions.
Additionally, if you have someone helping you with your claim, you should contact him/her. You or your representative may also contact the attorney in the Goodnight case:
Brent V. ManningManning Curtis Bradshaw & Bednar, LLC
3rd Floor, New House Building
10 Exchange Place
Salt Lake City, Utah 84111
Telephone (801) 363-5678
Si usted habla espanol y no entiende esta carta, favor de llevarla a la oficina de Seguro Social arriba mencionada para que se la expliquen.
Enclosures:
Reply Form and Envelope
Exhibit 2- Goodnight Reply Form
SOCIAL SECURITY ADMINISTRATION
GOODNIGHT V. APFEL REPLY FORM
IMPORTANT
RETURN THIS FORM WITHIN 90 DAYS TO REQUEST REVIEW OF YOUR GOODNIGHT CLAIM
Name |
DOC: |
Date: |
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Address |
M2 |
Social Security NO: |
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City, State ZIP |
Key Code: |
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Reference : |
IF YOU WANT YOUR CLAIM REVIEWED, PLEASE SIGN AND DATE THIS FORM. YOU MUST ALSO FILL IN THE FOLLOWING INFORMATION AND RETURN THE FORM IN THE SELF-ADDRESSED, PRE-PAID ENVELOPE.
SIGNATURE |
DATE |
Enter the area code and the telephone number where we can call you.
(AREA CODE) TELEPHONE NUMBER
WHAT YOU SHOULD DO IF YOUR ADDRESS HAS CHANGED
[ ] Check this block only if your address is different than shown above, and enter your correct address.
ADDRESS (NUMBER AND STREET, APT. NO., P.O. BOX, OR RURAL ROUTE)
CITY and STATE ZIP CODE
PLEASE NOTIFY SSA IF YOUR ADDRESS CHANGES AFTER YOU MAIL THIS RESPONDER FORM.
SIGNATURE |
DATE |
Privacy Act Notice
The Social Security Act (Sections 205(a) of title II, 702 of title VII, 1631(e)(1)(A) and (B) of title XVI, and 1869(b)(1) and (c) of title XVIII) allows us to collect the information on this form. We will use the information to process your claim. You do not have to give us this information, but without it we may not be able to process your claim. Information may be disclosed to another person or to another governmental agency for the administration of the Social Security program or for the administration of programs requiring coordination with the Social Security Administration. Explanations about these and other reasons why information you provided us may be used or given out are available in Social Security Offices. If you want to learn more about this, contact any Social Security office.
Exhibit 3- Goodnight Court Case Flag/Alert
GOODNIGHT COURT CASE FLAG/ALERT
TITLE: CATEGORY:
REVIEW OFFICE PSC MFT DOC ALERT DATE
BOAN or PAN NAME
CAN OR HUN RESPONSE DATE TOE
TITLE CFL CFL DATE ACN PAYEE ADDRESS
II
XVI
SHIP TO ADDRESS:
If claim is pending in OARO, ship folder to:
Office of Disability Adjudication and Review
Office of Appellate Operations (OAO)
One Skyline Tower, Suite 701
5107 Leesburg Pike
Falls Church, VA 22041-3200
ATTN: OAO Class Action Coordinator
(Case Locator Code 5001)
Exhibit 4- Court Case Folder Retrieval Worksheet
COURT CASE FOLDER RETRIEVAL WORKSHEET
1. Court Case Name |
Listing Code |
2. CAN/HUN |
BOAN/PAN |
Claimant's Name |
3. a. |
SOURCE/QUERY |
RESPONSE* |
DATE |
SOURCE/QUERY |
RESPONSE* |
DATE |
SSR/STALE |
|
provided |
OHAQ |
|
provided |
AR-25 |
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provided |
DDSQ |
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|
ODIO OVERNIGHT |
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provided |
BDIQ |
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|
FACT |
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provided |
SSID CCTL |
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|
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b. |
ODIO SPEC SEARCH*** |
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|
PCACS |
|
|
c. |
PSC SPEC SEARCH*** |
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4. LIST OF CLAIMS SEARCHED
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APPL |
ALLEGED |
DECISION DATE** |
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- *
Response should be YES/NIF (Not In File or No Record)/NA (Not Applicable).
- **
Show UNK if date cannot be determined.
- ***
-
Y = Medical evidence in folder; N = No medical evidence in folder or no folder located; D = Folder destroyed.
REMARKS:
5. All item 3. sources have been checked — see reverse for documentation — search ended.
Signature | Position/Location | Date |
FOLDER SEARCH DOCUMENTATION
a. Alert CAN/HUN Folders
SOURCE/ QUERY |
CONTACT DATE |
CONTACT LOCATION | *PHONE/FAX # OR ADM MSG RI |
CONTACT PERSON | **SEARCH RESULTS |
---|---|---|---|---|---|
b. Cross Reference Folders
SSN: (1) |
(2) |
(3) |
SOURCE/ QUERY |
CONTACT DATE |
CONTACT LOCATION | *PHONE/FAX # OR ADM MSG RI |
CONTACT PERSON | **SEARCH RESULTS |
---|---|---|---|---|---|
- *
Show (T) beside phone #, if telephone; show (F), if FAX.
- **
Y = Medical evidence in folder; N = No medical evidence in folder or no folder located; D = Folder destroyed.
Exhibit 5- Unfavorable Decision on Goodnight Class Membership Notice
SOCIAL SECURITY ADMINISTRATION
Important Information
DATE: | |
CLAIM NUMBER: | |
DOC: | |
FO ADDRESS: | |
Telephone: |
READ CAREFULLY - PLEASE RESPOND TO THIS NOTICE WITHIN 90 DAYS
We are writing to tell you that we received your request to review your earlier claim for disability benefits under the Goodnight court case. We have looked at your case and have decided that you are not eligible to have your claim reviewed. This means that we will not review our earlier decision.
A copy of this letter is being sent to your representative of record, if known, and the attorney for the Goodnight court case.
You may contact the class attorney in this case to obtain their assistance, if you think our decision is wrong. They will answer without charge your questions about eligibility for having your claim reviewed. The attorney's name, address, and telephone number is as follows:
Brent V. ManningManning Curtis Bradshaw & Bednar, LLC
3rd Floor, New House Building
10 Exchange Place
Salt Lake City, Utah 84111
Telephone (801) 363-5678
Reason For The Unfavorable Decision
You are not eligible to have your claim reviewed under the Goodnight court case because:
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We Are Not Deciding If You Are Disabled
It is important for you to know that we are not making a decision about whether you are disabled. We are deciding only that you are not entitled to a review of your claim under the Goodnight court case. If you do not agree with this decision, you have 60 days after receiving this notice to notify class counsel, at the address listed above, that you want to protest this decision and explain your reason(s) why.
If You Think You Are Disabled Now
If you are not currently receiving disability payments and you think you are disabled now, you may file a new application. A new application is not the same as asking us to review your claim under Goodnight . In the new application you may not be able to receive disability benefits for the period of time you asked for in your prior claim. If you decide to file a new application, contact any Social Security office.
If You Have Any Questions
If you have any questions, you may contact the class attorney at the address above or your local Social Security office. The Social Security address and telephone number are printed at the top of this letter. You may also call us toll free at 1-800-772-1213 if you have any questions. If you call or visit a Social Security office, please have this letter with you. It will help us answer your questions.
Si usted habla espanol y no entiende esta carta, favor de llevarla a la oficina de Seguro Social arriba mencionada para que se la expliquen.
cc:
Brent V. Manning
Manning Curtis Bradshaw & Bednar, LLC
Exhibit 6- Goodnight Good Cause Denial Notice
SOCIAL SECURITY ADMINISTRATION
Important Information
DATE: | |
CLAIM NUMBER: | |
DOC: | |
(Field Office Return Address): | |
(Field Office Phone Number): | |
Telephone: |
On , we sent you a letter about a court case called Goodnight v. Apfel . In that letter we said that you could ask us to review your prior disability claim, and that this could result in payment of disability benefits to you. We notified you that you had to reply to the letter within 90 days from the date you received the notice, if you wanted us to review your claim. Our records show that you did not ask for review until .
Under certain conditions, we can extend the time limit for you to request review. However, based on the facts that you gave us, we are unable to extend the time limit in your case. Accordingly, we cannot review your claim under the Goodnight v. Apfel court case.
If Your Have Any Questions
If you have any questions, you may contact your local Social Security office. The address and telephone number are printed at the top of this notice. If you call or visit a Social Security office, please have this letter with you. It will help us answer your question(s). You may also call us toll free at 1-800-772-1213 if you have any questions. If you have someone helping you with your claim, you should contact him/her. You or your representative may also contact the class attorney in the Goodnight case:
Brent V. Manning
Manning Curtis Bradshaw & Bednar, LLC
3rd Floor, New House Building
10 Exchange Place
Salt Lake City, Utah 84111
Telephone (801) 363-5678
Si usted habla espanol y no entiende esta carta, favor de llevarla a la oficina de Seguro Social arriba mencionada para que se la expliquen.
CC:
Brent V. Manning
Manning Curtis Bradshaw & Bednar, LLC
Exhibit 7 - Goodnight SSN Verification Notice
SOCIAL SECURITY ADMINISTRATION
Important Information
Date: |
|
DOC: |
|
FO Address: |
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FO Telephone: |
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Claim Number: - - |
You have asked us to review your claim for Social Security and/or Supplemental Security Income Disability benefits under the Goodnight court case. We have been unable to do so because we have no record that you ever filed an application for Social Security disability benefits or Supplemental Security Income disability benefits.
You might have given us the wrong Social Security number when you told us that you wanted to have your claim reviewed under the Goodnight court case. If you gave us the wrong number, that would explain why we have not been able to find a record of your claim. Please check your Social Security number carefully, and compare it to the following number. The number you gave us is . If this number is wrong, please write your correct Social Security number on the line above, marked “Claim Number.” Or, if you asked for Social Security benefits on someone else's record, please write that person's Social Security number on the line above, marked “Claim Number.” Return this letter in the enclosed envelope.
If you do not give us a new Social Security number, but you have evidence which shows that you filed a claim, please take the evidence, along with this letter, to your local Social Security office. We will take no further action on your request for review under the Goodnight court case. Please respond to this notice within 30 days from the date of this notice.
If You Have Other Questions
If you have any questions, you should call, write or visit any Social Security office. If you visit a Social Security office, please bring this letter with you. It will help us answer your questions. If you have someone helping you with your claim, you should contact him/her.
If You Have a Legal Representative or Would Like to Obtain One
You or your representative may also contact the attorney in this case. If you would like to obtain a legal representative, you may contact the attorney in this case. The attorney's name, address, and telephone number are as follows:
Brent V. ManningManning Curtis Bradshaw & Bednar, LLC
3rd Floor, New House Building
10 Exchange Place
Salt Lake City, Utah 84111
Telephone (801) 363-5678
Si usted habla espanol y no entiende esta carta, favor de llevarla a la oficina de Seguro Social arriba mencionada para que se la expliquen.
Enclosure:
Postage-paid Envelope
CC:
Brent V. Manning
Manning Curtis Bradshaw & Bednar, LLC
Exhibit 8 - Goodnight Screening Sheet and Instructions