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Form 26A 11/2014 Page 1 of 3 SELF-INSURED EMPLOYER OR CARRIER MAIL TO NCIC - CLAIMS ADMINISTRATION 4335 MAIL SERVICE CENTER RALEIGH NORTH CAROLINA 27699-4335 MAIN TELEPHONE 919 807-2500 HELPLINE 800 688-8349 WEBSITE HTTP //WWW.IC. NC. GOV/ 10. An overpayment is claimed in the amount of. Overpayment was calculated as follows. If overpayment claimed a Form 28B Report of Compensation and Medical Compensation Paid is attached. yes no 11. If applica.

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Keywords relevant to Ncic Form 26a

  • Raleigh
  • 1994
  • 28b
  • 18m
  • FEIN
  • claimant
  • ic
  • Helpline
  • overpayment
  • ext
  • undersigned
  • foregoing
  • hereto
  • disfigurement
  • applicable
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