II-6-8-10. SAMPLE Order Entering Additional Evidence into the Record (Court Cases)

SOCIAL SECURITY ADMINISTRATION
OFFICE OF HEARINGS AND APPEALS

ORDER OF APPEALS COUNCIL

In the case of
_______________________________ (Claimant)

Claim for
_______________________________

_______________________________

(Wage Earner)(Leave blank if same as above)

_______________________________

(Social Security Number)

The Appeals Council has received additional evidence which it is making part of the record. That evidence consists of the following exhibits:

[Add more exhibits as necessary]

Date:

_______________________________ Claimant	_______________________________ Social Security Number
_______________________________ Wage Earner

AC EXHIBITS LIST

[Add more exhibits as necessary]