Claimant: XXX X XXXXXXX
Level: Hearing
Application: XX/XX/XXXX
Level: Hearing
Application: XX/XX/XXXX
Claimant SSN: XXX-XX-XXXX
Last Insured: XX/XX/XXXX
Blind Last Insured: XX/XX/XXXX
Claim Type: T2
Last Insured: XX/XX/XXXX
Blind Last Insured: XX/XX/XXXX
Claim Type: T2
Last Change: XX/XX/XXXX
Alleged Onset: XX/XX/XXXX
Alleged Onset: XX/XX/XXXX
Exhibit List
A. Payment Documents/Decisions
Items: 2
Page Count: 0
| # | Description | Decision Date | Received | Marked | Pg | |
|---|---|---|---|---|---|---|
| 1A | Disability Determination Transmittal - 831 | Prior to Hearing | N | 0 | ||
| 2A | Disability Determination Transmittal - 831 | Prior to Hearing | N | 0 |
E. Disability Related Development
Items: 0
Page Count: 0
| # | Description | Source | Date From | Date To | Received | Marked | Pg |
|---|
F. Medical Records
Items: 0
Page Count: 0
| # | Description | Source | Date From | Date To | Received | Marked | Pg |
|---|