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Get the free Duplication of Benefits Affidavit - NCDA

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Duplication of Benefits Affidavit Date: ___ DUNS Number:___Business/Organization Name:___Part 1 This section identifies any sources of funds that the CDBCO applicant has applied for or received as
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How to fill out duplication of benefits affidavit

01
Obtain a copy of the duplication of benefits affidavit form from the relevant organization or agency.
02
Fill out all required personal information on the form, such as name, address, and contact details.
03
Provide details about the disaster or incident that led to the need for the duplication of benefits affidavit.
04
Disclose any other benefits or assistance received related to the disaster or incident.
05
Sign and date the affidavit to certify the information provided is true and accurate.
06
Submit the completed duplication of benefits affidavit to the appropriate party for review and processing.

Who needs duplication of benefits affidavit?

01
Individuals or households affected by a disaster or incident who have received financial benefits or assistance from multiple sources may need to fill out a duplication of benefits affidavit.
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The duplication of benefits affidavit is a form used to disclose any potential duplication of benefits received from multiple sources.
Individuals or entities who have received benefits from more than one source are required to file duplication of benefits affidavit.
The duplication of benefits affidavit must be filled out by providing accurate information about all benefits received from different sources.
The purpose of duplication of benefits affidavit is to prevent individuals from receiving duplicate benefits for the same loss.
The duplication of benefits affidavit must include information on all benefits received, including the source, amount, and date.
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