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Complaint For Judicial Review Social Security Case - Oregon
| Complaint For Judicial Review Social Security Case Form. This is a Oregon form and can be used in District Court Federal . |
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UNITED STATES DISTRICT COURT DISTRICT OF OREGON SELECT A DIVISION ____________________________________, Plaintiff, v. Case No:_____________ COMPLAINT FOR JUDICIAL REVIEW SOCIAL SECURITY CASE / COMMISSIONER SOCIAL SECURITY ADMINISTRATION, Defendant. 1. Plaintiff seeks judicial review of the Commissioner of Social Security's final agency decision [briefly explain the decision, e.g., denying his/her application for Social Security disability insurance benefits and Supplemental Security Income disability benefits]: American LegalNet, Inc. www.FormsWorkFlow.com The date of the final agency decision is [enter date]: ______________________. The date of the Appeals Council's denial of review is [enter date]: ______________________. 2. 3. Plaintiff is a resident of [enter county & state]: _________________________________. Plaintiff has exhausted his/her administrative remedies and this Court has subject matter jurisdiction under 42 U.S.C. ยง 405(g). WHEREFORE, Plaintiff seeks: Name: ____________________________________ OSB #:____________________________________ Telephone #: _______________________________ Attorney for: _______________________________ American LegalNet, Inc. www.FormsWorkFlow.com PRINT
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