Basic (03-86)

DI 43520.020 Optional Form 41

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).

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DI 43520.020 - Optional Form 41 - 01/23/1990
Batch run: 04/14/2014