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PGBA LLC Claims Direction Form For Military Treatment Facility Personnel Fax 855-831-7042 MTF Name DMIS ID Title Name Email Telephone Number Signature Date Reason for Contact Line of Duty LOD Point of Service POS Overturn Timely Filing Waiver within the last 6 years Other Reason Action Need provide claim number s dates of service s specific diagnosis etc.

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What is 855 831 7042 form?

The 855 831 7042 form is a tax form used for reporting certain types of income to the IRS.

Who is required to file 855 831 7042 form?

Individuals or businesses who receive the types of income that must be reported on the form are required to file the 855 831 7042 form.

How to fill out 855 831 7042 form?

The form can be filled out manually or electronically, following the instructions provided by the IRS.

What is the purpose of 855 831 7042 form?

The purpose of the 855 831 7042 form is to report certain types of income to the IRS for tax purposes.

What information must be reported on 855 831 7042 form?

The form requires information such as the amount of income received and the payer's identification number.