Transmittal Form for Social Security Benefits Cases

DATE:

TO:

Office of the General Counsel
Social Security Administration
Post Office Box 17054
Baltimore, Maryland 21203

FROM:

United States Attorney's Office

SUBJECT:

(Ct.: , No.: )

On the following action was taken regarding the above-captioned social security case:

1. An adverse decision was rendered by a:

( ) Magistrate (Recommended Decision)

( ) Magistrate (Final Decision)

( ) District Court

( ) Court of Appeals

2. The decision:

( ) Reversed or recommended reversal of the Commissioner's decision

( ) Remanded or recommended remand of the case to the Commissioner

( ) THE ORDER CONTAINS A TIME LIMIT FOR ACTION BY THE COMMISSIONER; ACTION MUST BE COMPLETED BY. See pages.

3. IMMEDIATE ACTION IS NEEDED REGARDING THE RESPONSE OF THE COMMISSIONER TO A MOTION FOR, OR A THREAT OF:

( ) Contempt

( ) Default

( ) Copies of appropriate papers in the above-noted action are attached.