Navigating insurance paperwork can be an overwhelming process, even for those of us with a degree in health care. To make things easier, many insurance providers provide detailed forms that allow you to quickly and easily submit the required information. One such form is UHC Form 07. If you've been tasked with filling out this document, don't worry - we're here to help guide you through the process! Keep reading for our comprehensive overview of UHC Form 07 and everything you need to know about completing it correctly.
| Question | Answer |
|---|---|
| Form Name | Uhc Form 07 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | UHC, Alimony/, inflannation, false |
ALIMONY / CHILD SUPPORT SELF CERTIFICATION
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Social Security # |
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I hereby certify that I receive $_______________________ per __________________ (week, month, year) to the support of:
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Date: |
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Print your name: |
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Tel. #: |
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Relationship: |
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Address |
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This form is to be used only if third party verification has been attempted, but cannot be obtained.
PENALTIES FOR MISUSING THIS CONTENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or irnproper uses of inflannation collected based on the consent flann. Use of the inflannation collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than$5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions formisusing the social security number are contained m the Social Security act at 208 (a) (6), (7) and (8). Violations of these provisions are cited as violations of 42 USC 408 (a), (6), (7) and (8).
Alimony/Child Support Self Certification |
UHC Form 07 (Rev. 1/2010) |