Read Privacy Act Statement, Penalty Statement, and ...
There are severe criminal and civil penalties for knowingly submitting a false, fictitious, or fraudulent claim (U.S. Code, Title 18, Sections 287 and 1001 and Title 31, Section 3729). INSTRUCTIONS . ITEM 1 - PAYMENT . Member must be on electronic funds (EFT) to participate in split disbursement. Split disbursement is a payment method by which
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