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1 <br /> . j <br /> w x <br /> �rDETAILED REVIEW CHECK LIST <br /> Page 3 w� - <br /> t' Claim No: Q Claimant Name: j <br /> GOMi?CIANCE DOCVMENTATfON <br /> DATE ACTtONIRESPONSE a ry <br /> O <br /> 1 i <br /> i <br /> Continued on Reverse <br /> 'CONFIRMaT10N OF CORREC:77yE ACTION GOMAttANCE <br /> Claimant in Corrective Action Compliance <br /> Claimant NOT in Corrective Action Compliance at the.,Time of this Review= 90 Day Letter Required <br /> Claimant NOT in Corrective Action Compliance - Recommend Rejection t <br /> LEAD AGENCY SIGNATURE .. DATE , <br /> CLAIMS REVIEWER SIGNATURE//�! :;.,. ATE <br /> USTCF025.DET (Rev 1195) " <br />