BASIC (08-03)

1. Exhibit 1 - Grant Potential Class Member Notices

2. Exhibit 2 - Grant Reply Form

3. Exhibit 3 - Grant Court Case Flag/Alert

4. Exhibit 4 - Grant Court Case Folder Retrieval Worksheet

5. Exhibit 5 - Grant Folder Flag Presumed Class Membership Case

6. Exhibit 6 - Grant Not Eligible for Relief Notice

7. Exhibit 7 - Grant Good Cause Denial Notices

8. Exhibit 8 - Grant Route Slip

9. Exhibit 9 - SSN Verification Notice
   
   
   

A. Exhibit 1 - Grant Potential Class Member Notice

Social Security Administration

Date:

Claim No:

DI:

DOC:

Telephone:

IMPORTANT NOTICE OF SETTLEMENT AND DEADLINE FOR APPLYING FOR A NEW HEARING –

PLEASE READ CAREFULLY

Please Respond To This Notice Within 90 days

Our records show that you applied for Social Security disability benefits or Supplemental Security Income (SSI) disability benefits, or both, and received a fully or partially unfavorable decision from Administrative Law Judge (ALJ) Russell Rowell on or after January 1, 1985. This is a notice of a settlement implementing a court order in the class action lawsuit, Grant v. Commissioner of the Social Security Administration, No. 3:CV-88-0921 (M.D. Pa), that challenged ALJ Rowell's hearing decisions. The court ordered the agency to provide new hearings to class members (people whose claims for disability or SSI disability benefits were denied by ALJ Rowell on or after January 1, 1985). This notice explains what you must do if you want us to review your claim again to determine if you are entitled to a new hearing before a different ALJ.

What to Do If You Want Us to Review Your Claim Again

If you would like us to review your claim again you must complete the enclosed “GRANT v. COMMISSIONER OF THE SOCIAL SECURITY ADMINISTRATION -- REVIEW REQUEST FORM” and send it to us in the enclosed postage-paid envelope. Even if you now get money from us, you still may be entitled to a new hearing. The result of that hearing may be that the agency owes you more money.

YOU MUST SEND US THE FORM WITHIN 90 DAYS OR WE WILL NOT REVIEW YOUR CLAIM AGAIN. DO NOT WAIT OR YOU MAY LOSE THE RIGHT TO HAVE YOUR CLAIM REVIEWED.

What We Will Do If You Ask Us to Review Your Claim Again

If you send us the enclosed “REVIEW REQUEST FORM,” we will check to see if you are entitled to have us review your claim again. After we finish our review, we will send you a notice telling you if you are entitled to a new hearing. If so, you will receive a new hearing before a different ALJ (not the ALJ who previously heard your claim).

If You Have Any Questions

If you have any questions about this notice or whether you should request a new hearing, or whether you should seek further review of a decision not granting a request for a new hearing, please call the lawyers from the Community Justice Project, Larry Norton or Peter Zurflieh who provided representation to plaintiffs in this class action, at their toll free number, 1-800-322-7572, extension 217, or write to them at Community Justice Project, 118 Locust St., Harrisburg, PA 17101. Also, call 1-800-322-7572, extension 217, if this notice is addressed to a person who is now deceased.

You may also contact your local Social Security office. The address and telephone number are printed at the top of this letter. If you call or visit an office, please have this letter with you. It will help us answer your questions.

If a lawyer or other representative was helping you at any time with your claim for disability benefits, you should contact that person and let him or her know about this notice.

Enclosures:

Reply Form and Envelope

Si usted no entienda esta carta, llevela a la officina de Seguro Social arriba mencionada para que se la expliquen.

B. Exhibit 2 - Grant Reply Form

Social Security Administration

GRANT v. COMMISSIONER OF SOCIAL SECURITY

REVIEW REQUEST FORM

______________________________________________________
IMPORTANT

RETURN THIS FORM WITHIN 90 DAYS

IF YOU WANT US TO REVIEW YOUR CLAIM AGAIN

[Name]                  DOC:      Date:
[Address]                 TA:        Social Security Number:

[City State ZIP]              Key Code:

                             Reference Number:
Claim Numbers:

IF YOU WANT US TO REVIEW YOUR CLAIM AGAIN, PLEASE SIGN AND DATE THIS FORM, AND RETURN IT IN THE ENCLOSED PRE-PAID ENVELOPE.

SIGNATURE_______________________

Date_______________________________

Please write the Area code and the telephone number where we can call you.

AREA CODE________ TELEPHONE NUMBER___________________

If your address is different from that shown above, please write your correct address.

ADDRESS (Number and Street, Apartment Number, Post Office Box, or Rural Route)

CITY AND STATE ZIP CODE

If your Social Security Number is different from that shown above, please write your correct Social Security Number.

________________________

SOCIAL SECURITY NUMBER

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 provide us may be used or given out are available in the Social Security offices. If you want to learn more about this, contact any Social Security office.

C. Exhibit 3 - Grant Court Case Flag/Alert

REVIEW PSC DOC TOE ALERT DATE RESPONSE DATE OLD BOAN/PAN

OFFICE

SSN (BOAN OR PAN)    NAME     BIRTH DATE       
REFERENCE #

FOLDER LOCATION INFORMATION

CAN/HUN      BIC/MFT  CATG  TITLE SITE  COMP  DATE   ACN

PAYEE ADDRESS

ALL CLAIM FILE(S) SHOULD BE SHIPPED TO THE FOLLOWING ADDRESS FOR SCREENING:

Office of Disability Adjudication and Review

Office of Appellate Operations

5107 Leesburg Pike, Room 701

Falls Church, VA 22041-3200

ATTN: ODAR Class Action Coordinator

(Case Locator Code Y46)

IF UNABLE TO LOCATE THE CLAIM FILE(S), FORWARD A RECONSTRUCTION REQUEST TO THE SERVICING FIELD OFFICE

*NOTE: A separate screening sheet must be prepared for each CAN/HUN printed above.

D. Exhibit 4 - Grant Court Case Folder Retrieval Worksheet

COURT CASE FOLDER RETRIEVAL WORKSHEET

1. Court Case Name: _____________ LIT Code: ____________________

2. SSN (BOAN/PAN) ________________ Date Search Began: ____________

Claimant's Name __________________________________________________

3. a. SOURCE/QUERY RESPONSE* DATE SOURCE/QUERY RESPONSE*DATE

SSR         __________ provided     OHAQ _____________   provided

AR-25        __________  provided     DDSQ______________   ___________

PCACS       __________  provided     SSI2 CCTL __________   ____________

FACT        __________  provided

b. ODIO SPEC SEARCH***     ____________         _________________

c. PSC SPEC SEARCH***       ______________        ___________________

4. LIST OF CLAIMS SEARCHED

CAN (BIC)/   APPL     ALLEGED     DECISION DATE***

HUN (ID)    DATE**    ONSET**    DENIAL  TERM  ALLOW   RESULTS**

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

* Response should be YES/NIF (Not in File or No Record)/NA (Not Applicable).

** Show UNK if date cannot be determined

*** Y = Folder is found and contains medical evidence; 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

6. FOLDER SEARCH DOCUMENTATION

a. Alert CAN/HUN Folders

SOURCE/  CONTACT  CONTACT  *PHONE/FAX #   CONTACT   **SEARCH

QUERY   DATE     LOCATION  OR ADM MISG RI  PERSON     RESULTS

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b. Cross Reference Folders

SSN: (1) _________________________   (2)___________________    (3) __________________

SOURCE/  CONTACT  CONTACT   *PHONE/FAX #   CONTACT     **SEARCH

QUERY   DATE    LOCATION   OR ADM MISG RI  PERSON      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.

E. Exhibit 5 - Grant Folder Flag Presumed Class Membership Notice

GRANT

PRESUMED CLASS MEMBERSHIP CASE

We have been unable to locate one or more potential Grant claims. Please reconstruct the missing potential Grant claims. Please reconstruct the missing claim(s) shown below. See the OHAQ query in the Grant alert-query package for more information about missing claims adjudicated by an ALJ.

                    Alleged

Claim    Filing    Decision    Onset or        Issue

Number   Date     Den or Cess   Cess Date    Med    Non-Med

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________         __________             ______________

Signature            Office               Date

F. Exhibit 6 - Grant Not Eligible for Relief Notice

You asked us to review your case under the terms of the Grant v. Commissioner of Social Security Administration settlement agreement. We have looked at your case and decided that you are not eligible for a new hearing decision under the Grant settlement agreement. The reason you are not eligible for a new hearing decision is checked below.

THIS NOTICE IS NOT A DETERMINATION ABOUT WHETHER YOU ARE

DISABLED.

It is important for you to understand that we are not making a decision about whether you are disabled. We are deciding only that you are not eligible for a new decision under the Grant settlement.

IF YOU DISAGREE WITH THIS DETERMINATION

You must write within 60 days of the date you receive this notice to:

Office of the General Counsel

Social Security Administration

Attn: Grant Attorney

611 Altmeyer Building

6401 Security Boulevard

Baltimore, MD 21235

It will be helpful if your letter tells us the reasons why you disagree with this determination.

IF YOU WANT MORE INFORMATION:

You may contact the lawyers who brought the Grant lawsuit. They can be reached as follows:

Larry E. Norton, II

Peter Zurflieh

Community Justice Project

118 Locust Lane

Harrisburg, PA 17101

Telephone: 1-800-322-7572, Extension 217

The Grant lawyers can provide information about the lawsuit, including the information about how to notify Social Security that you disagree with this determination.

Si usted no entiende esta carta, llevela a la oficina de seguro social para que se la expiquen.

G. Exhibit 7 - Grant Good Cause Denial Notice

Social Security Administration

Important Information
                          Social Security Administration

                           _____________________________

                            Address
                            ___________________________

                           __________________________
                           City   State  Zip Code

                             ___________________________

                            Telephone Number

                            ___________________________
                              Claim Number

___________________________________________

Claimant's Name

___________________________________________

Address

___________________________________________

City State Zip Code

We received your request for review of a prior ___________ [decision or dismissal] under a court case called Grant v. Commissioner of Social Security. The court order states that you had to request review within 90 days from the date notices were reviewed by potential class members. We will allow 5 additional days for mailing. This means that you had to request Grant review by __________. (If a claimant received a notice, 95 days from the last mailing date. If a claimant did not receive a notice, 95 days from the date of the initial 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. Therefore, we cannot review your claim under the Grant v. Commissioner of Social Security settlement agreement.

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 the notice. If you call or visit a Social Security office, please have this notice with you. It will help us answer your question(s). 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 Grant case:

Larry E. Norton, II

Peter Zurflieh

Community Justice Project

118 Locust Street

Harrisburg, PA 17101

Telephone No. 1- (800)-322-7572, Extension 217

Si usted habla espanol y no entiende esta carta, favor de llevarla a la oficina de Seguro Social arriba men-cionada para que se la expliquen.

H. Exhibit 8 - Grant Route Slip

ROUTING AND TRANSMITTAL SLIP         DATE:

TO            INITIALS        DATE

1.

2.

XX   ACTION      FILE             NOTE AND RETURN

    APPROVAL     FOR CLEARANCE        PER CONVERSATION

    AS REQUESTED   FOR CORRECTION       PREPARE REPLY

    CIRCULATE     FOR YOUR INFORMATION    SEE ME

    COMMENT     INVESTIGATE         SIGNATURE 

    COORDINATION   JUSTIFY

REMARKS

GRANT CASE

Claimant: ___________________________________

SSN: ________________________________________

We have determined that this claimant is a Grant class member eligible for relief. We are forwarding this file to the hearing office which should follow normal procedures for updating the file, if necessary. (See DI 52530.001 for background and DI 52530.010E. for necessary actions.)

Attachment:

From:_________________________ Suite/Building: _________________

Office of Disability Adjudication and Review Phone Number: ________________

I. Exhibit 9 - SSN Verification Notice

Social Security Administration

Important Information

Date:

DOC:

FO Address:

FO Telephone:

Claim Number:

You have asked us to review your claim for Social Security and/or Supplemental Security Income Disability benefits under the Grant 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. Our records show that you requested review of your past claim under Social Security number ___ - ___-___. Please check this Social Security number carefully. If you find that this number is wrong, please write the correct Social Security number on the line above, marked “Claim Number.” Return this letter in the enclosed envelope. If the number you gave us is correct, you

must provide evidence that you filed a claim under this Social Security number.

If we do not hear from you within 30 days from the date of this notice, we will take no further action on your request for review under the Grant v. Commissioner of Social Security lawsuit.

If you have any questions, you may call us toll free at 1-800-772-1213, or call your local Social Security office at XXX-XXXX. We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located:

    District Office

    Address

    City, ST ZIP

If you call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly. If you have someone helping you with your claim, you should contact him/her. You may also ask for legal help by contacting a legal aid organization in your area.

Enclosure: Postage-Paid Envelope