Pro Se Social Security Complaint
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Pro Se Social Security Complaint Form. This is a Indiana form and can be use in District Court Federal.
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Tags: Pro Se Social Security Complaint, Indiana Federal, District Court
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF INDIANA
INDIANAPOLIS DIVISION
Plaintiff,
vs.
MICHAEL J. ASTRUE, Commissioner
of the Social Security Administration,
Defendant.
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Cause No.
COMPLAINT
Comes now the plaintiff and for cause of action says the following:
1.
The plaintiff resides within the Southern District of Indiana.
2.
This is an action to review a final decision of the defendant Secretary of
Health and Human Services. This Court has jurisdiction over the action pursuant to Section
205(g) of the Social Security Act, as amended, 42 U.S.C. ยง 405(g).
3.
The plaintiff has previously filed application(s) for disability benefits and/or
supplemental security income with the defendant and after various proceedings has been
denied benefits.
4.
a.
The decision of the defendant Secretary is not supported by substantial
evidence and should be reversed.
b.
In addition, there were errors of law which require that the decision be
reversed, namely, that
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______________________
For Court Use:
NOS:
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865
COA:
42:405id
WHEREFORE, the plaintiff prays that the final decision of the Secretary be reviewed and
set aside, that the plaintiff be awarded benefits as previously sought and that the plaintiff
be awarded all other relief found just and proper.
(Signature of Plaintiff)
Date
(Print name)
(Street Address)
(City, State, ZIP)
(Telephone Number)
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