Last Update: 9/2/2005 (Transmittal I-2-64)
HA 01260.094 Sample - Exhibit
List (Final) and Exhibit List - Second Hearing (Final)
Renumbered from HALLEX section I-2-6-94
EXHIBIT LIST (FINAL)
LIST OF PROPOSED EXHIBITS
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_______________________________ (Claimant)
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_______________________________ (Social
Security Number)
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______________________________
_ (Wage Earner)
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______________________________ _ (Social
Security Number)
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EXHIBIT NUMBER
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DESCRIPTION
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NUMBER OF PAGES
|
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1
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Application for disability insurance
benefits dated January 11, 2003.
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4
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2
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Earnings Record dated January 26, 2003.
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1
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3
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DDS Determinations dated March 21, 2003
and June 15, 2003.
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3
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4
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Medical History and Disability Report
dated March 8, 2003.
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8
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5
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Medical report dated May 6, 2003, regarding
hospitalization for the period September 10, 2002 to September 11,
2002, received from Cook County Hospital.
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5
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6
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Medical report dated February 5, 2003,
from Ralph Jones, M.D., with Professional Qualifications.
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3
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7
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Copy of letter dated August 19, 2003
to James Rogers, Ph.D.
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1
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8
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Statement of Education and Experience
of James Rogers, Ph.D.
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4
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|
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RECEIVED DURING HEARING
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|
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9
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Medical report dated April 15, 2000 R.
Jones, M.D.
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2
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FORM HA-540-U6(6-88)
Prior editions may be used
ATTACH TO CLAIM FILE COPY OF THE
DECISION
EXHIBIT LIST — SECOND
HEARING (FINAL)
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EXHIBIT NUMBER
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DESCRIPTION
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NUMBER OF PAGES
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EXHIBITS
IN CONNECTION WITH PRIOR APPLICATION
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|
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1 - 47
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Exhibits from prior hearing.
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60
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B-1
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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.
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|
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B-2
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Request for Review of ALJ's Action, November
26, 2002.
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1
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B-3
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Appeals Council Exhibit—Medical
report dated November 30, 2002, from Joseph Jones, M.D.
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2
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B-4
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Appeals Council Exhibit—Professional
Qualifications of Joseph Jones, M.D.
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1
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B-5
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Action of Appeals Council on Request
for Review, dated December 17, 2002.
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1
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B-6
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Summons and complaint, dated December
29, 2002.
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5
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B-7
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Decision of the U.S. District Court for
the District of Oregon, dated July 6, 2003.
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4
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|
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EXHIBITS
IN CONNECTION WITH CURRENT
APPLICATION
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|
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B-8
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Application for period of disability
and disability insurance benefits, filed on August 2, 2003.
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4
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