SAMPLE Acknowledgment Letter, Review of Written Record




Claimant Name and Address        Employee:


                                 Last 4 Digits of Claim Number:                                                                    

Dear Claimant Name:


On [date objection letter received], the Final Adjudication Branch (FAB) received a letter of objection dated [date of letter] stating you object to the(district office)district office’s recommended decision of (date of RD) which recommends denial of your claim for benefits under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA).   


Your objections, along with the information in the file, will be carefully considered and included in our final decision.  If you have any additional evidence that you wish to be considered, it must be received by the FAB within 20 calendar days of this letter.  After that date, a review of the written record will be made and a final decision will be issued.  Any evidence you wish to be considered should be submitted to:


U.S. Department of Labor


Final Adjudication Branch


City, State Zip Code 


If you wish, you may submit such evidence via fax to (xxx) xxx-xxxx.  Please ensure that your file number shown above is noted on any documentation you send to this office.






Hearing Representative