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7. Is Oral Argument requested?
Yes No
If yes, your request will be granted or denied in the Board’s discretion pursuant to the Board’s Rules
of Procedure (Code of Federal Regulations 20 C.F.R. § 501.5 (rev. 2008)). You must state the specific
issue(s) to be argued and state in detail the specific reasons that an oral argument is necessary as part
of your appeal. The issues and supporting statement need not be long, but they should be as cl ear
and specific as possible. Should your request for oral argument be denied, the appeal will be decided
on the record. (Use additional sheets if necessary.)
PLEASE NOTE: By requesting Oral Argument you are confirming that you will appear in
Washington, DC at your own expense if oral argument is granted. Oral arguments are only
held in Washington, DC. The Board does not pay for travel, or any other expenses, related
to attending oral argument. Evidence that was not in the case record at the time of the
decision(s) appealed to ECAB cannot be submitted to the Board at oral argument.
8. Appellant’s Signature: (Date)
9. YOU DO NOT HAVE TO HAVE A REPRESENTATIVE IN ORDE R TO PURSUE
YOUR APPEAL. IF A REPRESENTATIVE IS DESIGNATED, THEN HE OR
SHE MUST SIGN THIS FORM CONSENTING TO REPRESENT YOU. My
authorized representative for the purpose of this appeal is:
Representative’s Name:
Mailing Address:
City, State, Zip Code:
Telephone Number:
10. Representative’s Signature: (Date)
If you have any questions concerning this form, call the Employees’ Compensation
Appeals Board at 1-(866) 487-2365 or send a facsimile (fax) to the Board at (202)
513-6833. To mail the form, address it to the Employees’ Compensation Appeals
Board, Office of the Clerk, U.S. Department of Labor, 200 Constitution Avenue,
N.W. Room S5220, Washington, D.C. 20210.
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