This form is an Assignment of Money Due. The assignor agrees to grant to the assignee all title and interest in a certain debt or money due as described in the agreement. The form also provides that it is the responsibility of the assignor to collect the debt.
Assignment Due Form For Benefits In Virginia
Category:
State:
Multi-State
Control #:
US-00422
Format:
Word;
Rich Text
Instant download
Description
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The Assignment of Benefits (AOB) must be in writing. People Who May Be Eligible For Medical Assistance.After completing the form, use the mailing addresses provided on Page 4. Submit your claim on a VA Form 21-526EZ (Attached). Make sure you complete and sign your application. Signing this form essentially means you consent to the hospital billing your auto insurance for your care. However, this is not usually to your benefit. Complete, print, and sign this Assignment of benefits form (highlighted fields can be completed online then printed).
