UNITED STATES DISTRICT COURT WESTERN DISTRICT OF MISSOURI DIVISION Plaintiff Commissioner of Social Security Defendant ) ) ) ) ) ) ) ) ) Case No. -SSA COMPLAINT INITIATING A SOCIAL SECURITY APPEAL Plaintiff Social Security entered on seeks review from the final decision of the Commissioner of . The final decision of the defendant was not based on substantial evidence in the record because (State specifically each reason why plaintiff is entitled to relief.) The final decision of the defendant should be Jurisdiction and venue is based on 405(g), 42 U.S.C. §1383(c)(3) or other applicable statute). (Remanded, modified and/or reversed). (For example, 42 U. S.C. § 1 American LegalNet, Inc. www.FormsWorkFlow.com (Name of plaintiff or attorney) (Street address) (City, State and Zip Code) (Telephone Number including area code) 2 American LegalNet, Inc. www.FormsWorkFlow.com