(06/2015) OALJ Subpoena to Produce Documents, Information or Objects or to Permit Inspection of Premises Page 1 of 3 United States Department of Labor OFFICE OF ADMINISTRATIVE LAW JUDGES In Re: (Plaintiff/Complainant/Claimant) v. OALJ Case No: (Defendant/Respondent/Employer/Carrier) SUBPOENA TO PRODUCE DOCUMENTS, INFORMATION, OR OBJECTS OR TO PERMIT INSPECTION OF PREMISES To: Address: Production: YOU ARE COMMANDED to produce the following documents, electronically stored information, or objects, and permit their inspection, copying, testing, or sampling of the material at your address set forth above and at the following Date and Time : Alternate to Personal Production: You may avoid personally producing the described items at your address set forth above by delivering copies of the described items to the following described location on or before the date and time set forth above. Place of Production: Inspection: YOU ARE COMMANDED to permit entry onto the designated premises, land, or other property possessed or controlled by you at the time, date and location set forth below, so that the requesting party may inspect, measure, survey, photograph, test, or sample the property or any designated object on it. Place of Inspection: Date: Time: The following provisions of the Code of Federal Regulations (C.F.R.) are attached - 29 C.F.R. §§18.56(c) and 18.52(a), relating to your protection as a person subject to a subpoena, and 29 C.F.R. §§18.56(d) and 18.56(e), relating to your duty to respond to this subpoena and the potential consequences of not doing so. This subpoena is issued upon the application of (indicate attorney/representative for named party): (Person requesting subpoena) (Address and Telephone Number) Firm Name Name Bar Number Phone Number Address City State Zip Code IN WITNESS WHEREOF the undersigned United States Administrative Law Judge has hereunto set his/her hand and caused the seal of the United States Department of Labor to be affixed. Signature of U.S. Administrative Law Judge Date To be valid, a raised USDOL Seal must appear here American LegalNet, Inc. www.FormsWorkFlow.com (06/2015) OALJ Subpoena to Produce Documents, Information or Objects or to Permit Inspection of Premises Page 2 of 3 NOTICES NOTICE: This subpoena is only valid in proceedings before the Office of Administrative Law Judges or Office of Workers' Compensation Programs. To be valid, this subpoena must bear a raised United States Department of Labor (USDOL) seal, and the signature of a Department of Labor (DOL) administrative law judges. 29 C.F.R. §18.56 Subpoenas(c) Protecting a Person Subject to a Subpoena. HIPPA NOTICE: In regard to the Privacy of Individually Identifiable Health Information under the Health Insurance Portability and Accountability Act of 1996, if this subpoena does not bear a raised USDOL seal and the signature of a DOL administrative law judge, it is not valid under 45 C.F.R. §§164.512(e), 164.512(f) or 164.512(l). (A) Electronically Stored Information Produced in Only One Form. The person responding need not produce the same electronically stored (1) Avoiding Undue Burden or Expense; Sanctions. A party or representative information in more than one form. responsible for requesting, issuing or serving a subpoena must take reasonable (D) Inaccessible Electronically Stored Information. The person responding steps to avoid imposing undue burden on a person subject to the subpoena. The need not provide discovery of electronically stored information from sources that the person identifies as not reasonably accessible because judge must enforce this duty and impose an appropriate sanction. (2) Command to Produce Materials or Permit Inspection. of undue burden or expense. On motion to compel discovery or for a (A) Appearance Not Required. A person commanded to produce protective order, the person responding must show that the information documents, electronically stored information, or tangible things, or to is not reasonably accessible because of undue burden or cost. If that permit inspection of premises, need not appear in person at the place of showing is made, the judge may nonetheless order discovery from such production or inspection unless also commanded to appear for a sources if the requesting party show good cause. The judge may deposition or hearing. specify conditions for the discovery. (B) Objections. A person commanded to produce documents or tangible (2) Claiming Privilege or Protection. (A) Information Withheld. A person withholding subpoenaed things or to permit inspection may serve on the party or representative information under a claim that it is privileged or subject to protection as designated in the subpoena a written objection to inspecting, copying, testing or sampling any or all of the materials or to inspecting the hearing-preparation material must: premises - or to producing electronically stored information in the form (i) expressly make the claim; and (ii) describe the nature of the withheld documents, communications, or or forms requested. The objection must be served before the earlier of tangible things in a manner that, without revealing information the time specified for compliance or 14 days after the subpoena is served itself privileged or protected, will enable the parties to assess the (i) At any time, upon notice to the commanded person, the serving party claim. (B) Information Produced. If information produced in response to a may move the judge for an order compelling production or inspection. subpoena is subject to a claim of privilege or of protection as hearing(ii) These acts may be required only as directed in the order, and the preparation material, the person making the claim may notify any party order must protect a person who is neither a party nor a party's officer that received the information of the claim and the basis for it. After from significant expense resulting from compliance. being notified, a party must promptly return, sequester, or destroy the (3) Quashing or Modifying a Subpoena. specified information and any copies it has; must not use or disclose the (A) When Required. On timely motion, the judge must quash or modify a information until the claim is resolved; must take reasonable steps to subpoena that: retrieve the information if the party disclosed it before being notified; (i) fails to allow a reasonable time to comply; and may promptly present the information to the judge in camera for a (ii) requires a pers