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.; no signature is required if filed by e-mail.) 2. Please include the following information in your letter, including whether the person(s) is a business and an address where information for review should be sent to (see note below). 3. If you are filing your letter in the name of the business, please include a list of all employees and an address where you can receive their correspondence. 4. Do not send this letter to agencies other than your own -- you will want to send your letter to the person(s) in (the appropriate case number) (name(s) listed) and tell them to submit comments and any attachments to the National Ombudsman's office (see below) with a copy. 5. If you want to include an attachment, please attach it to this letter in its entirety and include this statement: “This letter contains information concerning the above-noted matter. I am asking you to contact the Office of the National Ombudsman for a full review so that this information may be appropriately reviewed and/or corrected.” You will find a sample letter at the end of this form. You may also e-mail us at: 5/31/2013 Federal Agency Comments (Note: You can submit your comments with attachments to the National Ombudsman's Office by e-mail, but you can also submit them electronically or complete the form below.) OMB Control #4 Exp. Date 5/31/2013 Purpose: If a person wants to submit comments on a Federal Agency action, they may use this form to file their comments. Case.#: Instructions 1. Sign and date the form and send it to OMB and the specific Federal agency. 2. Please describe the information provided in your letter and the type of action that you are sending a comment on, including whether the person is a business. 3. The National Ombudsman will forward information on the issue to the agency, which has the authority to take response action. 4. If you do not submit your letter with attachments by the applicable deadline, the agency may complete and submit the comment based on the information you provided during the period in which you indicated you wished to submit the specific action. The OMB will not forward your letter or information regarding a specific action by another Government agency if you send a separate e-mail, fax, or postal letter explaining the additional information you wish you had included during that period.