By signing this form, you are giving permission for all Contract Providers for the County of San Diego, to bill your insurance for services rendered. Date. Step 1 - Print and Complete Form.Instructions: • Type or print legibly in ink. Return to Human Resources - Benefits Division, 5530 Overland Avenue, Suite 210. If the Collateral Assignment is to be released, the Assignee must complete a collateral release form dated prior to the Absolute Assignment. Print your name, fill in the date, and sign the form. If you need additional assistance with this form, contact the family law facilitator in your county. Federated's mySHIELD is a personalized, online destination for risk management resources to help support your business.