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Complaint For Review Of The Decision Of The Commissioner Of Social Security CIV-013 - West Virginia
| Complaint For Review Of The Decision Of The Commissioner Of Social Security Form. This is a West Virginia form and can be used in Southern District District Court Federal . |
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RESET FORM USDC/CIV-013 Complaint for Review of the Decision of the Commissioner of Social Security (Rev. 8/05) UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF WEST VIRGINIA AT SELECT ONE: Plaintiff, V. COMPLAINT FOR REVIEW OF THE DECISION OF THE COMMISSIONER OF SOCIAL SECURITY JoAnne B. Barnhart, Commissioner of Social Security, Defendant. CIVIL ACTION Plaintiff's current residence:_______________________________________________________ (city, county, state and ZIP code) Jurisdiction and venue is based on 42 U.S.C. ยง 405(g). Date of Appeals Council's decision:_________________________________________________ The decision of the Commissioner should be (mark those which apply): Reversed Modified Remanded because it is not supported by substantial evidence, and/or because the Commissioner committed other error which is ______________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Name of attorney, if any: _________________________________________________________ Attorney's street address: _________________________________________________________ _________________________________________________________ American LegalNet, Inc. www.USCourtForms.com USDC/CIV-013 Complaint for Review of the Decision of the Commissioner of Social Security (Rev. 8/05) Attorney's telephone number: _____________________________________________________ Attorney's fax number: __________________________________________________________ Attorney's email address:_________________________________________________________ ____________________________________ Signature of attorney ____________________________________ Signature of plaintiff, if no attorney American LegalNet, Inc. www.USCourtForms.com
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