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Certification of Health Care Provider for Employees Serious Health Condition (Family and Medical Leave Act)U.S. Department of Labor Wage and Hour Division DO NOT SEND COMPLETED FORM TO THE DEPARTMENT

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How to fill out filing your telephone claims

01

Step 1: Gather all necessary information, such as your telephone bill, account number, and any supporting documents.

02

Step 2: Review the instructions provided by your telephone provider or insurance company on how to fill out the claim form.

03

Step 3: Complete the claim form accurately and legibly, ensuring that all required fields are filled in.

04

Step 4: Attach any supporting documents, such as receipts or proof of purchase, as required.

05

Step 5: Double-check the completed claim form and supporting documents for any errors or omissions.

06

Step 6: Submit the claim form and supporting documents to the designated address or online portal provided by your telephone provider or insurance company.

07

Step 7: Keep a copy of the claim form and supporting documents for your records.

08

Step 8: Follow up with your telephone provider or insurance company to track the progress of your claim and address any further requirements if needed.

Who needs filing your telephone claims?

01

Anyone who has experienced issues with their telephone service or billing and is eligible for filing claims according to the terms and conditions of their telephone provider or insurance policy.

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