Crime Victims Provider's Request for Adjustment

Información del documento
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Título

Crime Victims Provider's Request for Adjustment

(Un formulario electrónico)- 651 KB PDF)
Descripción

Used by providers to request an adjustment to their bill if their entire bill was paid in error, or if a portion of the bill was overpaid or underpaid. Attach required reports and/or documentation to support the request.

Detalle
Número del formulario F800-064-000
Disponibilidad Online only
Palabras claves bill adjustment, billing errors, bills, crime victims compensation, cvc, industrial insurance, overpayment, refund, underpayment, worker's compensation, workers compensation, workers' compensation
Idiomas English
Fechas válidas 12-2013
Contacto
Páginas de Internet Help for Crime Victims

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