I-4-1-92. Exhibit - Sample Annotated Exhibit List — Six Part Folder

Last Update: 9/13/05 (Transmittal I-4-15)

LIST OF EXHIBITS

Claimant: [Claimant Name] SSN: [SSN]

[Cross-ref Name:] [Xname] [Xref SSN:] [XSSN]

Exh. No.	Part No.	Description	No. of Pages
PAYMENT DOCUMENTS/DECISIONS
[Exh No.]	A	[Description of Exhibit]	[No. of Pages]
JURISDICTIONAL DOCUMENTS/NOTICES
[Exh No.]	B	[Description of Exhibit]	[No. of Pages]
NON-DISABILITY DEVELOPMENT
[Exh No.]	D	[Description of Exhibit]	[No. of Pages]
DISABILITY-RELATED DEVELOPMENT AND DOCUMENTATION
[Exh No.]	E	[Description of Exhibit]	[No. of Pages]

LIST OF EXHIBITS

Claimant: [Claimant Name] SSN: [SSN]

[Cross-ref Name:] [Xname] [Xref SSN:] [XSSN]