Form SSA-887 Summary of Evidence

Form Approved

SOCIAL SECURITY ADMINISTRATION

O M B NO. 0980-0430

CODE NUMBERS

SUMMARY OF EVIDENCE

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PRIVACY/PAPERWORK ACT NOTICE: The Social Security Administration (SSA) is authorized t o collect the information on this
form under section 205(a), 1631(e)(l)(A) and (6). and 1872 of the Social Security Act (the Act), as amended (42 U.S.C. 405,
1383, and 1395ii). Giving us this information is mandatory. This form will be used as a means for listing medical/vocational
reports included in claims folders of cases where the evidentially hearings process required by section 205(b) of the Act and 2 0
CFR sections 404.91 3(b), 404.914(a), 41 6.141 3(b), and 41 6.141 4(a) applies.
CLAIMANT'S NAME

NUMBER HOLDER'S SOCIAL SECURITY NUMBER

List in chronological order (newest to oldest based on date of report) all medical and vocational reports of information pertaining
to the issue of disability which were considered in the development of the case. Include physicians' reports (specify if
consultative examinations (CEs)), hospital records, medical or vocational test results.
A. MEDICAL/VOCATIONAL REPORTS SINCE COMPARISON POINT DECISION

6. MEDICALNOCATIONAL REPORTS AT COMPARISON POINT DECISION

Form SSA-887 (7-1 992) (EF 1-2004)

'U.S. Government Printing Office: Z304--304-659100204

The following revised PRA Statement will be inserted into the form at its
next scheduled reprinting:
Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction
Act of 1995. You do not need to answer these questions unless we display a valid Office
of Management and Budget control number. We estimate that it will take about 15
minutes to read the instructions, gather the facts, and answer the questions. Send only
comments relating to our time estimate above to: SSA, 6401 Security Blvd, Baltimore,
MD 21235-6401.