I-3-2-18.Samples — Proffering Evidence Through the Field Office

A. Sample - Memorandum to Field Office (FO)

Office of Appellate Operations (OAO) staff will prepare a memorandum to the FO using the standard memorandum format and including language similar to the following:

This case is now pending before the Appeals Council. Your prompt attention to this request is appreciated. We have attached a copy of a letter notifying the claimant that we have received additional evidence that the Appeals Council proposes to add to the record. This case requires special handling and proffer of the evidence in the claimant's local field office.

Please inform the claimant that the additional evidence will be available for review at your office for 10 days from the date of your letter. Please send me a copy of your letter to the claimant so that I may add it to the record.

Because the Appeals Council has jurisdiction over the case, personnel in your office should not discuss the evidence with the claimant. However, please record any specific request from the claimant so that we can respond.

If the claimant examines the evidence in your office, have [him/her] complete Item A of the attached “Examination of Evidence” document. The claimant should then sign and date the form in the appropriate spaces. If there is no response to your 10-day letter, please sign and date Item B.

Upon completion of your action, please [return all material to this office in the attached envelope/upload signed or completed documents to the electronic file, with any additional information the claimant submitted, and destroy duplicate copies of information already in the record].

Attachments:

• Copy of letter to claimant

• List of additional evidence

• Copy of additional evidence

• Examination of evidence document

• Self-addressed envelope

B. Sample - Examination of Evidence Document

OAO staff will prepare an examination of evidence document similar to the following for use by the FO:

EXAMINATION OF EVIDENCE

DESCRIPTION OF ADDITIONAL EVIDENCE

[List Additional Evidence Here]

Claimant to check any applicable statements:

___ I examined the above listed evidence and have no comments to make.

___ I examined the above listed evidence and have noted comments on the attached documents.

___ I have no further evidence to submit.

___ I am submitting the following evidence:

___ I do not wish the evidence to be forwarded to my medical source.

___ I wish the evidence to be forwarded to my medical source for comments.

The name and address of my medical source is:

[Add the following options as applicable per the instructions in Hearings, Appeals and Litigation Law manual I-3-2-16]

[___ I do not wish to request a supplemental hearing to discuss this evidence.]

[___ I wish to request a supplemental hearing to discuss this evidence.]

[___ I do not wish to question, either orally or in writing, the author(s) of this (these) report(s).]

[___ I wish to question, either orally or in writing, the author(s) of this (these) report(s).]

The claimant did not respond to our 10-day letter.

C. Sample - Letter to Claimant

OAO staff will prepare a letter to the claimant, with a copy to the appointed representative (if any), using standard correspondence format and including language similar to the following:

Dear [NAME]:

We have received additional evidence that the Appeals Council proposes to add to the record of your case. We have documented this evidence on the attached List of Additional Evidence. We are sending this evidence to the Social Security office shown below so you can review it. That office will notify you when the evidence is available for your review, and they will give you 10 days to come to the office to review the information. Because your case is before the Appeals Council, employees in the local Social Security office cannot discuss the evidence with you or provide a copy of the information to you.

However, the local Social Security office will provide you a document on which you can submit any comments in writing. If you have additional evidence or any statement regarding the facts and law in your case, you may also submit them at that time. If you want us to forward the evidence to your medical source for him or her to review, please so indicate and provide the physician's name and address.

[You may request a supplemental hearing with respect to this evidence and, if required for a full and true disclosure of the facts in your case, you may request to orally question the author(s) of this (these) report(s)].

The Social Security office will tell us if they do not hear from you within 10 days of the date of their notice. We will then assume that you do not wish to examine or comment on the evidence or request a supplemental hearing, and that you have no further documentation to submit. We will carefully consider your case and issue a decision on the evidence of record.

Enclosures

[List of additional evidence]

cc: [local Social Security office]

D. Sample - List of Additional Evidence

OAO staff will use the same general format used to preparing exhibit lists. For example:

LIST OF ADDITIONAL EVIDENCE

1. Medical report from Robert T. Jones, M.D. dated July 5, 1988.

2. Professional qualifications of Robert T. Jones, M.D.