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 |
|
|
B-8 |
Application for period of disability and disability insurance benefits, filed on August 2, 2003. |
4 |