We have identified the following overpayment and are in good faith voluntarily refunding all monies collected in error. Please download the form, complete each field and print.Include the form with your refund so we can properly apply the refund and record the receipt. View options for satisfying overpayment. Submit a Voluntary Refund - A voluntary refund is when an overpayment has been self-identified. No refunds are processed on withdrawn classes. If you have received a letter in the mail from Moab Regional Hospital informing you of a credit balance on your account as a result of an overpayment. Utah Free Refund Demand Letter Template. Use our free Refund Demand Letter template to request the return of a payment. If you do not respond, you may: • Have your payments stopped.