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Get and Sign Form Uia 1733 Protest of a Determination
PENCIL* I WISH TO PROTEST THE DETERMINATION APPEAL THE DETERMINATION DO YOU HAVE INFORMATION THAT WAS NOT PROVIDED PRIOR TO THE RE DETERMINATION DATE RE DETERMINATION WAS ISSUED DATE SHOWN AT BOTTOM OF RE DETRMINATION FOR THE FOLLOWING REASON S IF APPLICABLE I DID NOT PROTEST OR APPEAL WITHIN 30 CALENDAR DAYS OF WHEN I certify that the information I have provided on this form is true and correct to the best of my knowledge and belief* Your Signature Date NOTE IF YOU NEED MORE SPACE ATTACH...
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