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United States Department of Labor Employees Compensation Appeals Board ___ S.M., Appellant and DEPARTMENT OF VETERANS AFFAIRS, ROCKY MOUNTAIN REGIONAL VA MEDICAL CENTER, Aurora, CO, Employer ___ Appearances:

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How to fill out 22-1095o sm and department

01

Fill out personal information such as name, address, and social security number in the appropriate sections on the form.

02

Complete the section regarding the department you are affiliated with or receiving benefits from.

03

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Who needs 22-1095o sm and department?

01

Individuals who are applying for benefits through the Department of Veterans Affairs may need to fill out form 22-1095o sm and specify their department.

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