Last Update: 9/13/05 (Transmittal I-4-15)
DOCUMENTATION OF CIVIL ACTION FILING DATE
OFFICE OF HEARINGS AND APPEALS
MEMORANDUM FOR THE FILE
|
________________________ Date |
_______________________ Claimant's Name |
|
________________________ Civil Action Number |
_______________________ Wage Earner |
|
________________________ Court's Phone Number |
_______________________ Social Security Number |
____________________________________________________
Contact with the Office of the Clerk, United States District Court for
the
____________________ District of ___________________
Person called: __________________________ Person's Title: ____________________
A civil action was filed on ______________________________
If in forma pauperis,
petition filed on
___________________ and granted on ____________________
____________________________
Civil Action Assistant