Crime Victims Provider's Request for Adjustment

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Title Crime Victims Provider's Request for Adjustment

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.

Document number F800-064-000
How to get this document
Keywords bill adjustment, billing errors, bills, crime victims compensation, cvc, industrial insurance, overpayment, refund, underpayment, worker's compensation, workers compensation, workers' compensation
Alt Language(s)
Valid dates 12/2013
Contact information
Websites Help for Crime Victims

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