Reason | [field-value] | Prior Appeal Case | [Case Reference No.] |
---|---|---|---|
Receipt Method | [field-value] | Emergency | [field-value] |
Effective Date | [Date] | Deadline Date | [Date] |
Timely | [True] | Continue Benefits | [True] |
Receipt Acknowledged | [True] | Appealed Status | [field-value] |
Comments
[Comments] |