Joint Appendix One

,_Case2:10-cv-O7678-JFW-_B Document1 Filed 10/14/10 _le28of32
UNITED STATES DISTRICT COURT, CENTRAL DISTRICT OF CALIFOP.NIA
CIVIL COVER SHEET
VIII(a). IDENTICAL CASES: Has this action been previously filed in this court and dismissed, lemanded or Closed? _Wo 13 Yes
tfyes, list ca.'in number(s):
Vl|l(h), RELATED CASES: Haveanycasesbecnprcvious]yfiledinlhiscourttilatarcrelatedtethcpmscntcas¢? _No _Yes
If yes. h_t c_¢ number(s):
Civll cases a re deemed related if a previously flied case and the present case:
(Ch¢_'k all bOxes that apply) OA. Arlscfromth¢_arne[_rcloselyretatcdtraus,_ctions, happenings, or cv_nts; or
C/R. Call for dctecminaticm _ffthe same _r sub_ 't_nd_lty _elated or _imilar questions ofla_u and f_¢q _
[3 C, For other reasons would entail substantial duplication of labor if beard by different judges; or
O D. Involve the same patent, ffaden_,a_k or copyfighq and one of the facto_ identifled above in a, b or c also i_ present.
IX. VENUE: (When¢ompledng the [ollowinginfomvadon, useanadditionalshcet if neces._ary,)
Page ID #:32 I
(a) List the County in this District; California County outside oflhls District; St:tie if other than Califotnia; or Forclga Country., in which EACH named plaiatiffzcsides.
O Check here if the _t_vcrnn,'enL its a_¢neie._ or cmpM:cees is a named plaintiff, If this box is checked, 6o,[0 item {b). , , I
(b) List the County in this District; California Corn ty outside of this District; State if other than Califomla; or Foreign Country, in which EACH named defendant re_idcs
[3 Check here if the [overnment, its a_encics or ¢tnpIovees is a nanxed d¢fcndanL If this box is checked, _o to item (c).
(c) List the County in this District; California Couuly ouLside of this District; State if other than California; or Forclgn Country, in which _ACII claim arose.
Nolo: In land condemnation cases, use the location of the tract of land Involved.
County in this District:* California County omside of this Disuict; State, if other Ihmt California: or Foteign Count*3'
Riverside
* Los Ang¢|cs, Orange, San Bernardlno, Riverside, Ventura, Santa Barb=rao or Sire Luis Obispo Counties
X. SIGNATURE OF ATTOPJ'/EY (OR PRO PER):( ___ Date October 14, 2010
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NoIIce to Counsel/Parties: Th¢CV_7_S-44_Civi_C_verSheeta_dtheinf_rmati_nc_ntained_t_i_n¢ith_rr_p_a¢_n_rsup_em_tthe_iugands_i_fp_ead_ngs
or other papers as required by law. This form, approved by the Judicial Conference of the United States in Septenther 19"/4, is required pursuant to Local Rule 3-1 is not filed
but {s u_ed by the Clerk of th_ Cot_ for the puq_ose _f statistics, _rtrmt and initiating the civil docket sheet. IFor more dot ailed insWac fions, see sepa rate instructions sheet.)
Key to Statistical codes relating to Social Security Cases:
Nature of Suit Code Abhrevlation
gfl Ilia
862 ilL
863 DIWC
863 - DIWW
864 SSID
g65 RSI
Substattti_e Staten',enI of Caas¢ of A¢tlon
All claims fur tw.¢ tth insurance benefits (Medicare) under Title I g, Part A. of the Social Security Act, as amended.
Also, include claims by hospitals, skilled nursing facilities, etc., for certification _s provlde_ o f sol'vices under Ihe
program. (42 U.S.C. 1935FF(b))
All claims for "Black Lung" benefits under Title 4, Part B, of tile Federal Coal Mine Health attd Safety Act tff 1969.
(30 U.S.C. 923)
All tidings filed by insured workers for disability insurance benefits under Title 2 of the Social Security Act, as
amended; plus all claims filed for ehiki's i_sutattce bee.cries basc_t on disability. (42 U.S.C. 40S_g))
All claims filed flit widows or widowers insurance henefit:t based on disabili W trader Title 2 of the Social Secudty
Act, as amended. (42 U,S.C. 405(g))
All claims for supplemental security income payments bsscd upon disability filed under Title t 6 of the Social Security
Act. as anmnded.
All claims for retirement (old age} and survivors benefits under Title 2 of the Son/a! Security Act, as amended. (42
u,s.c. (g))
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