DEEOIC CASE TRANSFER SHEET

Employee Name:

Case File Number:

Docket Number (If applicable):

Claimant(s) Name(s)

(other than employee)

1.

2.

3.

4.

5

TRANSFER FROM:

DISTRICT OFFICE

FINAL ADJUDICATION BRANCH

NATIONAL OFFICE

Cleveland CE2 Unit

Denver

Jacksonville

Seattle

Cleveland

Denver

Jacksonville

Seattle

Washington DC

Director

Policy Branch

CE2 Unit

TRANSFER TO:

DISTRICT OFFICE

FINAL ADJUDICATION BRANCH

NATIONAL OFFICE

Cleveland CE2 Unit

Denver

Jacksonville

Seattle

Cleveland

Denver

Jacksonville

Seattle

Washington DC

Director

Policy Branch

CE2 Unit

REASON FOR DO’s / CE2 UNIT’S / NO’s TRANSFER: REASON FOR FAB’S TRANSFER:

FAB Review

Recommended Decision Reconsideration

Policy/Procedure

Reopen Remand Challenge

Policy Question Solicitor

Medical Director Industrial Hygienist

Toxicologist Health Physicist

Remand Reversal Affirmation

Reopen Policy Question Solicitor

Medical Director Industrial Hygienist

Toxicologist Health Physicist

Send Copy of Final Decision to:

NIOSH DOJ (RECA) RC _________

STATUS

Part B

Part E

ECMS Final Decision Coding

Part B: Part E:

AOP Amount

Part B:

Part E:

COMMENTS / OTHER

Accept

Deny

Defer