Repayment Application Routing Form

Date:
Pages:1

Page 1 of a refund Repayment Application Routing Form. It contains the following information:

Applicant's Name: Lisa Boss

Amount: 2995.00

FSM: Sandy Porter

It also contains six steps, which include sending information to the Ethics Officer and the Sr ED, sending the claimant to the Qual Sec and Qual Consultant, sending the folder (it doesn't say whether it's the PC folder or another folder) to the Sr C/S,
back to Qual for handling, to Ethics for more handling, and finally step 6, "Claimant is routed onto his next service, or offloaded."

There are blanks to initial and date each step as it is completed. None of the spaces is initialled.

FSO 2536