FORM 6B. USERRA Notification Form Form 6B Rev. 03/16 UNITED STATES COURT OF APPEALS FOR THE FEDERAL CIRCUIT v. Case No. USERRA Notification Form INSTRUCTIONS: In a petition for review of a Merit Systems Protection Board decision, a petitioner is not required to pay the docketing fee or costs if the case involved a claim under the Uniformed Services Employment and Reemployments Rights Act of 1994 (USERRA). 38 4 U.S.C. § 4323, 4324. Check the statement below indicating that the Board appeal involved a USERRA claim and sign this form only if the underlying appeal at the Board involved a USERRA claim. The signed original should be submitted within 14 days of the date of docketing to: Clerk of Court at the address shown below. One copy should be sent to counsel for the respondent. Because the underlying appeal at the Merit Systems Protection Board involved a USERRA claim, the petitioner is not required to pay the docketing fee or costs. I certify that a copy of this form was sent to the attorney for the respondent, at the following address: , Date Signature of pro se or counsel Counsel should electronically file in CM/ECF. Pro se should mail original to: Clerk of Court United States Court of Appeals for the Federal Circuit 717 Madison Place, NW Washington, DC 20439 American LegalNet, Inc. www.FormsWorkFlow.com