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This document presents the decision and order of the United States Department of Labor's Employees’ Compensation Appeals Board regarding the case of Tessie B. Tebia vs. U.S. Postal Service, International

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1. Start by entering your personal information such as your name, address, and contact details in the appropriate sections of the form.
2. Provide the relevant details regarding the Department of Labor (DOL) case number, including the claimant's name and Social Security number.
3. Fill in the details of the representative or attorney representing the claimant, if applicable.
4. In the "Statement of Medical Facts" section, provide a detailed description of the claimant's medical condition and how it affects their ability to work.
5. Include any medical reports, test results, or other supporting documentation that can substantiate the claimant's condition.
6. Describe any work-related activities the claimant can still perform, along with the restrictions or limitations they may have.
7. Provide information about the claimant's prior employment history, including the dates of employment and job responsibilities.
8. If the claimant is receiving or has applied for any other benefits, disclose the details in the relevant section.
9. Sign and date the form, and ensure that the claimant or their representative also signs and dates it.

Who needs 04-1055doc - dol:

1. Individuals who are filing a claim with the Department of Labor (DOL) for disability benefits.
2. Claimants seeking assistance or representation for their disability case from an attorney or representative.
3. Medical professionals or experts who need to provide medical reports or other supporting documentation for the claimant's case.

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04-1055doc - dol is a specific document required to be filed with the Department of Labor.

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The individuals or entities mandated by law or regulation are required to file 04-1055doc - dol.

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To fill out 04-1055doc - dol, you need to gather the necessary information and follow the instructions provided by the Department of Labor. They may have specific guidelines or forms to be used.

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