PAYMENT ELIGIBILITY INFORMATION Sample Clauses

PAYMENT ELIGIBILITY INFORMATION. Please review the notice and sections 2.3 through 2.8 of the Settlement Agreement (available at xxx.xxxxxx.xxx) for more information on who is eligible for a payment. Please provide as much information as you can to help us figure out if you are entitled to a settlement payment.
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PAYMENT ELIGIBILITY INFORMATION. To prepare for this section of the Claim Form, please review the Settlement Notice and Sections 2.1 through 2.3 of the Settlement Agreement (available for download at [settlement website]) for more information on who is eligible for a payment and the nature of the expenses or losses that can be claimed. To help us determine if you are entitled to a settlement payment, please provide as much information as reasonably possible.
Sample 1
PAYMENT ELIGIBILITY INFORMATION. Please review the Notice and sections 2.1 through 2.2 of the Settlement Agreement (available at [INSERT WEBSITE]) for more information on who is eligible for a payment and the nature of the expenses or losses that can be claimed. Please provide as much information as you can to help us figure out if you are entitled to a Settlement payment. Please provide the information listed below: Check the box for each category of documented out-of-pocket expenses, fraudulent charges, or lost time that you incurred as a result of the Data Incident. Please be sure to fill in the total amount you are claiming for each category and to attach documentation of the charges as described in bold type (if you are asked to provide account statements as part of proof required for any part of your claim, you may mark out any unrelated transactions if you wish).
Sample 1
PAYMENT ELIGIBILITY INFORMATION. Please review the notice and paragraph 39 of the Settlement Agreement (available at xxx.XXXXXXXXXXXXXX.xxx) for more information on who is eligible for a payment and the nature of the expenses or losses that can be claimed. Please provide as much information as you can to help us figure out if you are entitled to a settlement payment. Please provide the information listed below: Check the box for each category of out-of-pocket expenses, fraudulent charges, or lost time that you incurred/experienced as a result of the Data Breach. Please be sure to fill in the total amount you are claiming for each category and to attach documentation of the charges as described in bold type (if you are asked to provide account statements as part of proof required for any part of your claim, you may mark out any unrelated transactions if you wish).
Sample 1
PAYMENT ELIGIBILITY INFORMATION. Please review the notice and section 2.1 of the Settlement Agreement (available at www. .com) for more information on who is eligible for a payment and the nature of the expenses or losses that can be claimed. Please provide as much information as you can to help us figure out if you are entitled to a settlement payment. Please provide the information listed below: Check the box for each category of your expenses that you had to pay as a result of the Data Incident. Please be sure to fill in the total amount you are claiming for each category and to attach documentation of the charges as described in bold type (if you are asked to provide account statements as part of proof required for any part of your claim, you may xxxx out any unrelated transactions if you wish).
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PAYMENT ELIGIBILITY INFORMATION. Please review the notice and sections ## through ## of the Settlement Agreement (available at www.<<URL>>) for more information on who is eligible for a payment. Please provide as much information as you can to help us figure out if you are entitled to a settlement payment. Settlement Class Members who file a valid claim will be eligible to receive an equal share of the Net Settlement Fund from Froedtert regarding the Data Incident. Settlement Class Members will receive only one payment. I attest that I logged into a MyChart patient portal account through Froedtert’s website at least once between February 1, 2017 and May 23, 2022.
Sample 1
PAYMENT ELIGIBILITY INFORMATION. To prepare for this section of the Claim Form, please review the Settlement Notice and Sections
Sample 1
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PAYMENT ELIGIBILITY INFORMATION. Please review the Notice and sections 2.1 through 2.2 of the Settlement Agreement (available at [INSERT WEBSITE]) for more information on who is eligible for a payment and the nature of the expenses or losses that can be claimed. Please provide as much information as you can to help us figure out if you are entitled to a Settlement payment. Please provide the information listed below: Check the box for each category of documented out-of-pocket expenses, fraudulent charges, or lost time that you incurred between March 7, 2023, and the Claims Deadline as a result of the Data Incident. Please be sure to fill in the total amount you are claiming for each category and to attach documentation of the charges as described in bold type (if you are asked to provide account statements as part of proof required for any part of your claim, you may mark out any unrelated transactions if you wish).
Sample 1

Related to PAYMENT ELIGIBILITY INFORMATION

  • Eligibility Information Group shall provide timely and accurate eligibility information, including Medicare status, and identify all persons subject to the Medicare Secondary Payer statutes and regulations. Group acknowledges that BCN will rely upon the accuracy of all eligibility information Group provides, and Group shall indemnify and hold BCN harmless against any loss, claim or action, including costs, penalties and reasonable attorney fees, arising from the provision of inaccurate eligibility information.

  • Client Eligibility Client eligibility and service referral are the responsibility of DDA under chapter 388- 823 WAC (Eligibility) and chapter 388-825 WAC (Service Rules). Only persons referred by DDA shall be eligible for direct Client services under this Program Agreement. It is DDA’s responsibility to determine and authorize the appropriate direct service(s) type. Direct Client services provided without authorization are not reimbursable under this Program Agreement.

  • Employment Eligibility Verification As required by IC § 22-5-1.7, the Contractor swears or affirms under the penalties of perjury that the Contractor does not knowingly employ an unauthorized alien. The Contractor further agrees that:

  • Student Eligibility A. The Texas Success Initiative (TSI) requires mandatory assessment for all students to determine college readiness in reading, writing and math. The xxxx authorizes the Texas Higher Education Coordinating Board to prescribe assessment instruments with a statewide passing standard. The initiative allows an institution to determine when a student is ready to perform college‐level coursework. High School students who seek to register in a dual credit course, which will grant college credit must prove “college readiness” by achieving a college level score as outlined in Appendix A.

  • Exclusions from Confidential Information Receiving Party's obligations under this Agreement do not extend to information that is: (a) publicly known at the time of disclosure or subsequently becomes publicly known through no fault of the Receiving Party; (b) discovered or created by the Receiving Party before disclosure by Disclosing Party; (c) learned by the Receiving Party through legitimate means other than from the Disclosing Party or Disclosing Party's representatives; or (d) is disclosed by Receiving Party with Disclosing Party's prior written approval.

  • Employees - Special Eligibility The following employees are also eligible to participate in the Group Insurance Program:

  • Employee Eligibility Verification The Contractor warrants that it fully complies with all Federal and State statutes and regulations regarding the employment of aliens and others and that all its employees performing work under this Contract meet the citizenship or alien status requirement set forth in Federal statutes and regulations. The Contractor shall obtain, from all employees performing work hereunder, all verification and other documentation of employment eligibility status required by Federal or State statutes and regulations including, but not limited to, the Immigration Reform and Control Act of 1986, 8 U.S.C. §1324 et seq., as they currently exist and as they may be hereafter amended. The Contractor shall retain all such documentation for all covered employees for the period prescribed by the law. The Contractor shall indemnify, defend with counsel approved in writing by County, and hold harmless, the County, its agents, officers, and employees from employer sanctions and any other liability which may be assessed against the Contractor or the County or both in connection with any alleged violation of any Federal or State statutes or regulations pertaining to the eligibility for employment of any persons performing work under this Contract.

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