TN 45 (07-05)

(GN 03102.425)

Document Identifier For Word Processor: E3474

A. Exhibit Letter

You asked us to take another look at your claim for Social Security (1) benefits. Someone who did not make the first decision reviewed you case, including any new facts you gave us. After this review, we found that our first decision was correct.

(Optional)

3474A You are not entitled to benefits because (1) (2) .

On the enclosed form, we discuss the reasons for our decision in more detail.

3474B

Do You Disagree With The Decision?
If you disagree with the decision, you have the right to request a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge. The judge will review those parts of the decision which you disagree with and consider any new facts you have. The judge may also review those parts which you agree with and may make them unfavorable or less favorable to you.

• You have 60 days to ask for a hearing.

• The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it,
  unless you show us that you did not get it within the 5-day period.

• You must have a good reason if you wait more than 60 days to ask for a hearing.

• You have to ask for a hearing in writing. If you want to make a request, please contact one of our offices. We can help you complete the required form.

Or

3474BF

If you disagree with the decision, you have the right to request a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge. The judge will review those parts of the decision you disagree with and consider any new facts you have. The judge may also review those parts which you agree with and may make them unfavorable or less favorable to you.

• You have 60 days to ask for a hearing.

• The 60 days start the day after you receive this letter.

• You must have a good reason if you wait more than 60 days to ask for a hearing.

• You can only have a hearing in the United States. You would have to pay any costs for traveling to the United States for the hearing. If you cannot come to the hearing, the judge will review your case plus any new information you send us. We will send you a letter about the judge's decision.

You have to ask for a hearing in writing. Contact us if you want help.

Or

3474C

If you disagree with the decision, you have the right to request a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge. The judge will review your case again and consider any new facts you have.

• You have 60 days to ask for a hearing.

• The 60 days start the day you receive this letter. We assume you got this letter 5 days after the date on it,  unless you show us that you did not get it within the 5-day period.

• You must have a good reason if you wait more than 60 days to ask for a hearing.

• You have to ask for a hearing in writing. If you want to make a request, please contact one of our offices. We can help you complete the required form.

Or

3474D

If you disagree with the decision, you have the right to request a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge. The judge will review those parts of the decision you disagree with and consider any new facts you have. The judge may also review those parts which you agree with and may make them unfavorable or less favorable to you.

• You have 60 days to ask for a hearing.

• The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it, unless you show us that you did not get it within the 5-day period.

• You must have a good reason if you wait more than 60 days to ask for a hearing.

• You have to ask for a hearing in writing. We will ask you to fill out a Form HA-501, called “Request for Hearing.” If you want to make a request, please contact one of our offices. We can help you fill out the form.

Please read the enclosed pamphlet, “You Right to an Administrative Law Judge Hearing and Appeals Council Review of Your Social Security Case.” It contains more information about the hearing.

Or

3474E

If you disagree with the decision, you have the right to request a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge. The judge will review your case again and consider any new facts you have.

• You have 60 days to ask for a hearing.

• The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it, unless you show us that you did not get it within the 5-day period.

• You must have a good reason if you wait more than 60 days to ask for hearing.

• You have to ask for a hearing in writing. We will ask you to fill out a Form HA-501, called “Request for Hearing.” If you want to make a request, please contact one of our offices. We can help you fill out the form.

Please read the enclosed pamphlet, “Your Right to an Administrative Law Judge Hearing and Appeals Council Review of Your Social Security Case.” It contains more information about the hearing.

Or

3474CF

If you disagree with the decision, you have the right to request a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge. The judge will review your case again and consider any new facts you have.

• You have 60 days to ask for a hearing.

• The 60 days start the day after you get this letter.

• You must have a good reason if you wait more than 60 days to ask for a hearing.

• You can only have a hearing in the United States. You would have to pay any costs for traveling to the United States for the hearing. If you cannot come to the hearing, the judge will review your case plus any new information you send us. We will send you a letter about the judge's decision.

• You have to ask for a hearing in writing. Contact us if want help.

  (Optional)

  If You Want Help With Your Appeal

  REPC01 and REP002

  (Optional)

   

  New Application

  3900A

   

  If You Have Any Questions

  3901C - Domestic

  3901D - Foreign

   

  Enclosure:

  SSA Pub. No 70-10281¹

  Form SSA-662 or Form SSA-1227

   

  ¹ Omit this enclosure in foreign case.

B. Requesting Instructions

This is the cover letter for Form SSA-662 and Form SSA-1227, reconsideration determination.

• Use REPC01, REP002, 3474A, 3474E, 3900A and 3901C when affirming a domestic denial/disallowance.

• Use 3474A, 3474CF, 3900A and 3901D when affirming a foreign denial/ disallowance.

• Use REPC01, REP002, 3474D and 3901C when affirming a domestic allowance.

• Use 3474B when affirming a Medicare entitlement allowance.

• Use 3474C when affirming a Medicare entitlement disallowance.

• Use 3474BF and 3901D when affirming a foreign allowance.

• Refer to NL 00703.100 for REPC01 and REP002 text.

• Refer to NL 00703.900 for 3900A text.

• Refer to NL 00703.005E. for 3901C and 3901D text and fill-ins.

Fill-ins:

1. Type of benefits, e.g., “retirement” or “disability”

2. Amended Decision? (Y/N)
   If “Y” is shown then the last sentence of the first paragraph would be changed to “After this review, we amended our decision.”

Paragraph 3474A

1. Insert a dictated sentence summarizing the reason for affirming the disallowance.

C. Typing Instructions

Use Form SSA-L2000-C2 (Universal Notice) and follow the notice standards. The fill-ins for the notice will be provided by the Reconsideration Specialist, who will indicate whether Form SSA-662 or Forms SSA-1227 is needed