Get Attestation Of Expenses For Personal Home Assistance Form To Request The Payment Of Expenses For

This guide provides comprehensive instructions for filling out the Attestation Of Expenses For Personal Home Assistance Form to request payment for assistance expenses. The process is tailored for users of all experience levels, offering step-by-step guidance to ensure accuracy and completeness in your application.

Follow the steps to complete the form efficiently and accurately.

1. Click ‘Get Form’ button to obtain the Attestation Of Expenses For Personal Home Assistance Form and open it in the editor.
2. Enter the claim number and the last name and first name of the accident victim in the appropriate fields.
3. In Section 1, the accident victim should review the details and sign to certify that the information provided is accurate. Include the date of signing.
4. If you wish for the payment to be made directly to the person providing assistance, complete Section 2. Sign and date this section accordingly.
5. Proceed to Section 3, where the person providing assistance must provide their last name and first name, address, and postal code. They should declare the amount they will receive weekly for the services provided, and then sign and date the section.
6. If services were provided over multiple periods or by different people, fill out Section 4 using the same details as in Section 3. This must also be signed and dated.
7. Once all sections are completed and reviewed for accuracy, save your changes. You can then download, print, or share the completed form as needed.

Start filling out your Attestation Of Expenses For Personal Home Assistance Form online now.