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Get U.S. Department Of Labor Duty Status Report - Blm

Or the employee named below. This request OMB No. 1215-0103 Expires: 08-31-05 does not constitute authorization for payment of medical expense by the Department of Labor, nor does it invalidate any previous authorization issued in this case. This request for information is authorized by law (5 USC 8101 et seq.) and is OWCP File Number required to obtain or retain a benefit. Information collected will be handled and stored in compliance with the Freedom (If known) of Information Act, the Privacy.

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