INSTRUCTIONS FOR FILING AN ACTION FOR REVIEW OF A SOCIAL SECURITY DECISION U.S. DISTRICT COURT, CENTRAL DISTRICT OF ILLINOIS 1. Please use the complaint form provided by the clerk of this court. Fill out the form completely. It is most important that you include your social security number, your full name and address and a telephone number where you can be reached during the day. You must file one original complaint and three (3) copies for service. You must remember to make a copy for yourself to retain. You must fill out a summons form and Form USM-285 (provided by the Clerk) for each of the following: Office of Regional Chief Counsel Region 5, Social Security Administration 200 W Adams St., 30th Fl Chicago, IL 60606-5208 Alberto Gonzales, Attorney General of the United States Dept. of Justice 10th and Constitution Ave. Washington, DC 20530 Rodger A. Heaton, U.S. Attorney 318 S Sixth St. Springfield, IL 62701 3. If you cannot pay the $350.00 filing fee, you must fill out an Application to Proceed In Forma Pauperis. This affidavit is available from the Clerk's Office. If you are allowed to file your complaint with out prepayment of fees , the United States Marshal will serve the summons and complaint for you. If you pay the filing fee, you are responsible for serving the summons and complaint. See Federal Rules of Civil Procedure 4(i). If you want to have an attorney appointed for you, you must fill out a request for appointment of counsel, available from the Clerk's Office. THE COURT STRONGLY ENCOURAGES YOU TO SEEK AN ATTORNEY OR TO REQUEST APPOINTED COUNSEL.
Legal Aid for Central Illinois can assist you in finding an attorney, and may, in some cases, provide an attorney for you. You should contact Legal Aid by calling 1-800-747-5523. (Rev. 9/19/06)