United States Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Civil Remedies Division
In the Case of:
Date:
Petitioner,
- v. -
The Inspector General.
INSPECTOR GENERAL’S/PETITIONER’S INFORMAL EXHIBIT LIST
If your Informal Brief refers to exhibits, you must assemble and mark them
exactly as required by Civil Remedies Division Procedures paragraph 3. You
must list and attach them to this Exhibit List.
I. G./Petitioner’s Exhibit 1:
Title or Description of Exhibit:
Date of Exhibit:
Number of pages in Exhibit:
Docket No. C-
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I. G./Petitioner’s Exhibit 2:
Title or Description of Exhibit:
Date of Exhibit:
Number of pages in Exhibit:
I. G./Petitioner’s Exhibit 3:
Title or Description of Exhibit:
Date of Exhibit:
Number of pages in Exhibit:
I. G./Petitioner’s Exhibit 4:
Title or Description of Exhibit:
Date of Exhibit:
Number of pages in Exhibit:
I. G./Petitioner’s Exhibit X, etc.:
Title or Description of Exhibit:
Date of Exhibit:
Number of pages in Exhibit:
This Exhibit List, as well as any attached Exhibits, must be submitted at the same
time that your Informal Brief is submitted. A copy of all Exhibits and this Exhibit
List must be provided to the I.G./Petitioner at the same time.
Counsel for I.G./Petitioner
Date:
Print Form