Prepare this routing and transmittal slip as a cover sheet for an SSA-432-U6/SSA-423A-U5
to inform a DO of INTPSC's development actions on a claim.
This form is preprinted. complete the DO address and DO number and staple it to the
DO copy of the SSA-423-U6 or SSA-423-U5.
(See Exhibit E., DI 43520.070).