Insurance Match File: Daily Reporting Manually

Report Lump Sum

Report Lump Sum – Organization Information

Report Lump Sum – Claimant Information

Report Lump Sum – Payment Information

The Paperwork Reduction Act of 1995 (Pub.L. 104-13): Public reporting burden for this voluntary collection of information is estimated to average 0.1 hours, per
response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. Any confidential
information collected for this program is protected and secured in accordance with 42 U.S.C. § 653(m). A federal agency may not conduct or sponsor, and a person
is not required to respond to, a collection of information, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact [email protected].