| Appeal Request | In which capacity are you filing this application? If Authorized Representative: | Letter of Representation | <Authorized Representative> | Provide a letter of representation stating that the authorized representative has the authority to act on the claimant’s behalf. | |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |