If a claimant submits (walk-in, mail, fax, email) a Form HA-520-U5, a letter, fax,
email message, or other written document to request AC review, complete the Form HA-520-U5
and process it per the instructions in GN 03104.200.
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•
Document the request for review date as the postmark, date-stamp, fax, or email message
date.
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•
Document that the claimant made the request by letter, fax message, email message,
or other written document, when the claimant submits the request for review on a document
other than the Form HA-520-U5.
Attach the letter, fax, email message, or other written document, to the claims folder
copy of the appeal form and a legible copy of it to each remaining copy of the form
as detailed in GN 03104.200.
EXCEPTION: If the letter, fax, email message, or other written document, is marked “confidential,”
do not make the additional copies. The AC determines if the material can be included
in the official record.