I-2-6-94.Sample - Exhibit List (Final) and Exhibit List - Second Hearing (Final)

Last Update: 9/2/05 (Transmittal I-2-64)

EXHIBIT LIST (FINAL)

LIST OF PROPOSED EXHIBITS

_______________________________ (Claimant)

_______________________________ (Social Security Number)

______________________________ _ (Wage Earner)

______________________________ _ (Social Security Number)

EXHIBIT NUMBER

DESCRIPTION

NUMBER OF PAGES

1

Application for disability insurance benefits dated January 11, 2003.

4

2

Earnings Record dated January 26, 2003.

1

3

DDS Determinations dated March 21, 2003 and June 15, 2003.

3

4

Medical History and Disability Report dated March 8, 2003.

8

5

Medical report dated May 6, 2003, regarding hospitalization for the period September 10, 2002 to September 11, 2002, received from Cook County Hospital.

5

6

Medical report dated February 5, 2003, from Ralph Jones, M.D., with Professional Qualifications.

3

7

Copy of letter dated August 19, 2003 to James Rogers, Ph.D.

1

8

Statement of Education and Experience of James Rogers, Ph.D.

4

RECEIVED DURING HEARING

9

Medical report dated April 15, 2000 R. Jones, M.D.

2

FORM HA-540-U6(6-88)

Prior editions may be used

ATTACH TO CLAIM FILE COPY OF THE DECISION

EXHIBIT LIST — SECOND HEARING (FINAL)

EXHIBIT NUMBER

DESCRIPTION

NUMBER OF PAGES

EXHIBITS IN CONNECTION WITH PRIOR APPLICATION

1 - 47

Exhibits from prior hearing.

60

B-1

ALJ's decision dated November 19, 2002: Notice of Decision, list of exhibits marked 1 thru 47, and transcript of hearing held on November 1, 2002.

 

B-2

Request for Review of ALJ's Action, November 26, 2002.

1

B-3

Appeals Council Exhibit—Medical report dated November 30, 2002, from Joseph Jones, M.D.

2

B-4

Appeals Council Exhibit—Professional Qualifications of Joseph Jones, M.D.

1

B-5

Action of Appeals Council on Request for Review, dated December 17, 2002.

1

B-6

Summons and complaint, dated December 29, 2002.

5

B-7

Decision of the U.S. District Court for the District of Oregon, dated July 6, 2003.

4

EXHIBITS IN CONNECTION WITH CURRENT
APPLICATION

B-8

Application for period of disability and disability insurance benefits, filed on August 2, 2003.

4