I-4-1-112.Exhibit - Fill-in Draft Declaration — Res Judicata — (DCL 13)

Last Update: 9/13/05 (Transmittal I-4-15)

IN THE UNITED STATES DISTRICT COURT
FOR THE [N / E / W / S / M / C] DISTRICT OF [STATE]
[DIVISION]

[CLAIMANT'S NAME]

)

 

[SSN]

)

 
 

)

 
 

)

 

Plaintiff

)

 
 

)

 

vs.

)

CIVIL ACTION NO. [Number]

 

)

 
 

)

 

[COMMISSIONER'S NAME]

)

 

COMMISSIONER OF

)

 

SOCIAL SECURITY

)

 
 

)

 
 

)

 

Defendant

)

 
 

)

 
 

)

 

DECLARATION OF [BRANCH CHIEF NAME]
COURT CASE PREPARATION AND REVIEW BRANCH [Number]
OFFICE OF HEARINGS AND APPEALS

SOCIAL SECURITY ADMINISTRATION

{2}

I, [System copies BRANCH CHIEF NAME from {1}], [Acting] Chief of Court Case Preparation and Review Branch [System copies Branch Number from {1}] of the Office of Appellate Operations, Office of Hearings and Appeals, Social Security Administration, declare and state as follows:

{3}

(1) Under direct delegation from the Commissioner of Social Security, the Office of Hearings and Appeals administers a nationwide hearings and appeals program. The Office of Hearings and Appeals includes the Appeals Council and Administrative Law Judges who hold hearings on claims arising under [Title II / Title XVI / Titles II and XVI] of the Social Security Act, as amended, when such hearing is duly requested by a claimant who is dissatisfied with the administrative determination of a claim. The Office of Appellate Operations provides professional and technical advice to the Associate Commissioner and Administrative Appeals Judges of the Appeals Council in the processing of cases in which a civil action has been filed.

{4}

(2) One function of the Appeals Council is to act on requests for review of hearing decisions made by Administrative Law Judges and to either grant, deny or dismiss any such request. Under the regulations of the Social Security Administration, if the Appeals Council denies a timely request for review of a hearing decision, that hearing decision becomes the “final decision” within the meaning of, and subject to, the provisions for judicial review in section 205(g) of the Social Security Act, as amended (42 U.S.C. section 405(g)), the first sentence of which reads as follows:

“Any individual, after any final decision of the Commissioner made after a hearing to which he was a party, irrespective of the amount in controversy, may obtain a review of such decision by a civil action commenced within sixty days after the mailing to him of notice of such decision or within such further time as the Commissioner may allow.***”

{5}

(3) Social Security Administration regulations [System-generated based on claim Title(s) in {3}: No. 4, section 404.957 (20 CFR 404.957) / No. 16, section 416.1457 (20 CFR 416.1457) / Nos. 4 and 16, sections 404.957 and 416.1457 (20 CFR 404.957 and 416.1457)] provide that a request for a hearing may be dismissed, either entirely or as to one or more issues, on the basis of res judicata. Subsection (c)(1) of the above regulation provides as follows:

“The doctrine of res judicata applies in that we have made a previous determination or decision under this subpart about your rights on the same facts and on the same issue or issues, and this previous determination or decision has become final by either administrative or judicial action.”

[System-generated based on claim Title(s) in {3}: {a} Sections 404.958, 404.959 and 404.967 of Regulations No. 4 (20 CFR 404.958, 404.959 and 404.967) (b) Sections 416.1458, 416.1459 and 416.1467 of Regulations No.16 (20 CFR 416.1458, 416.1459 and 416.1467) (c) Sections 404.958, 404.959, 404.967 and 416.1458, 416.1459 and 416.1467 of Regulations Nos. 4 and 16 (20 CFR 404.958, 404.959 and 404.967 and 416.1458, 416.1459 and 416.1467)] direct that notice of any such dismissal and the right to request review thereof by the Appeals Council shall be given to all parties.

{6}

(4) I am responsible for the processing of claims under [System copies Title from {3}] of the Social Security Act, as amended, whenever a civil action has been filed in the State of [System copies State from {1}]. The official file maintained by the Office of Hearings and Appeals relating to the claim of the plaintiff, [CLAIMANT'S NAME], under [System copies Title from {3}] of the Social Security Act, is presently within my legal custody and has been examined under my supervision. To the best of my knowledge and belief said file shows that:

{7}

(a) [User keys in sufficient detail regarding the history of the case to show that the res judicata dismissal by the ALJ was appropriate and that the AC's action on the request for review was proper (that the RJD has not been vacated).]

{8}

In accordance with 28 U.S.C. §1746, I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and belief.

{9}

___________________ Date

________________________________________ [BRANCH CHIEF NAME]