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 Washington
Category:
State:
Multi-State
Control #:
US-00422
Format:
Word;
Rich Text
Instant download
Description
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You may call the Child Care Subsidy Contact Center at 1- to request a form. How do I apply for cash or food assistance?Complete, print, and sign this Assignment of benefits form (highlighted fields can be completed online then printed). Suppliers can submit this form with initial enrollment, or up to 90 days after the enrollment date. Sample form: Flexible Assignment Deadline Form screenshot. NOTICE: Patients are not required to complete this assignment of benefits form.
