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Get Ha1 Form Railroad Disibility

Nt Notice on the next page and the accompanying Form HA-2 before completing this form. RETURN the completed form to: RRB Claim Number Print Name (First, Middle Initial, Last) Print Address (Number, Street/Apt. No., Po Box) Bureau of Hearings and Appeals Railroad Retirement Board 844 North Rush Street Chicago, Illinois 60611-2092 City State ZIP Code Telephone Number ( ) A. I hereby appeal the reconsideration decision reported in a letter dated . B. I.

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