I-1-2-104.Exhibit - Fee Agreement Recommendation

Last Update: 1/28/03 (Transmittal I-1-44)

Claimant's Name ____________________________________

Claim Number ____________________________________

Representative's Name ______________________________________

FEE AGREEMENT RECOMMENDATION
[Select the applicable bullet and check the basis or bases under the bullet, as necessary.]

I reviewed the fee agreement.

I prepared for the AAJ's signature, an Appeals Council Order based on the above.

 

________________________________
Signature

 

________________________________
Date