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

 

Initiated by:            

                                Name/Title                                                                                Date

 

Authorizing            ______________________________________                        ______________________________

Signature                 Name/Title                                                                               Date

 

                              ______________________________________                        ______________________________