Social Security Complaint Statistical Information | | Connecticut

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Social Security Complaint Statistical Information | | Connecticut

Last updated: 3/22/2012

Social Security Complaint Statistical Information

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Description

SOCIAL SECURITY COMPLANT STATISTICAL INFORMATION This document is a statistical information sheet which is not docketed as part of your complaint. This document is required and must be completed and served on the United States Attorney's Office as part of the packet included with your complaint. Plaintiff's Name: Address: City/State: Zip Code: SS Number: Phone: Email: Case Number: Request for Administrative Record: Disk Paper Both Date: Signature of Plaintiff: Please mail completed statistical information to: United States Attorney's Office New Haven Office Connecticut Financial Center 157 Church Street Floor 23 New Haven, CT 06510 American LegalNet, Inc. www.FormsWorkFlow.com Rev. 01/24/11

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