Get Reca Application Onsite Participant Claim Bformb - University Of Bb - Medicine Nevada

This guide provides clear and supportive instructions for completing the RECA Application Onsite Participant Claim Form. Following these steps will ensure that you fill out the form accurately and gather the necessary documentation for your claim.

Follow the steps to successfully fill out your claim form.

1. Click ‘Get Form’ button to obtain the RECA Application Onsite Participant Claim Form and open it for editing.
2. Begin with Part 1 where you will enter your personal information such as first name, last name, mailing address, and contact numbers. Ensure all details are accurate.
3. If applicable, indicate your membership in an Indian Tribe by checking the appropriate box and providing your census number.
4. Move to Part 2 if you are not the individual who became ill. Here, enter the claimant's information including their name, date of birth, and social security number.
5. In Part 3, clarify your relationship to the person who became ill by selecting the correct option, such as self, spouse, child, etc.
6. Proceed with the appropriate part based on your relationship: Self-fillers complete Part 4, surviving spouses Part 5, surviving children Part 6, and parents/grandchildren/grandparents Part 7.
7. Complete Part 8 by providing information on the person's onsite participation in any relevant activities and the corresponding dates.
8. In Part 9, select the compensable disease that the individual contracted from the list provided.
9. Answer questions in Part 10 regarding any previous payments you or the claimant received linked to the illness.
10. Fill out Part 11 by indicating whether you have submitted medical records or want the Radiation Program to contact cancer registries.
11. Complete the attorney sections as needed in Parts 12 to 14, ensuring all required signatures are included.
12. Sign and date Part 15 of the form, verifying that all information is accurate.
13. After filling out all relevant sections, save any changes, and you may then proceed to download, print, or share the completed claim as necessary.

Complete your claim form online today to ensure your submission is processed efficiently.