Form 6B FORM 6B. USERRA Notification Form 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 U.S.C. § 4323. 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 sent to: Clerk, United States Court of Appeals for the Federal Circuit, 717 Madison Place, NW, Washington, DC 20439. 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 American LegalNet, Inc. www.FormsWorkflow.com