TN 5 (04-21)
GN 03105.070 FO Folder Retrieval Checklist — Exhibit
Identifying data (complete all applicable items):
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Appellant Name (if different):
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Cross reference SSN/BOAN (if any):
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Type of Case (circle one): Hearing AC Review Civil Action
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Date HA-501 (HO copy) forwarded to OHO:
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Type of Folder(s) Needed (check all applicable):
( ) SSI Aged
( ) SSI Blind/Disabled
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( ) current folder ( ) prior folder
( ) T2 DI B
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( )current folder ( ) prior folder
( ) DWB
( ) RSI
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8.
( ) Other
Query Information(show pertinent information and attach copies):
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Field Office Actions
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c.
Date of follow-up request:
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