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RESETSUBMITPRINTAgency Claim No.:SSN/EIN:CLAIMS COLLECTION LITIGATION REPORT (CCLR)Before submitting the CCLR, review the Agency Checklist Submission Requirements at the end of the form.1.2.Agency

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Locate the designated fields for the referring agency and sub-agency name on the form.

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If applicable, write the name of the sub-agency under the referring agency in the designated space.

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What is referring agency/sub-agency name?

The referring agency/sub-agency name is the official designation of the government or organizational body that is responsible for overseeing or managing specific programs or operations. It typically identifies the entity that has made a referral or is providing specific services.

Who is required to file referring agency/sub-agency name?

Any organization, individual, or entity that receives referrals from or is involved with the referring agency/sub-agency is typically required to file the referring agency/sub-agency name, which includes compliance reports and documentation.

How to fill out referring agency/sub-agency name?

To fill out the referring agency/sub-agency name, you will generally need to provide the official name of the agency or sub-agency, as well as any relevant contact information, including addresses, phone numbers, and e-mail contacts. Ensure to follow any specific guidelines provided by regulatory authorities.

What is the purpose of referring agency/sub-agency name?

The purpose of the referring agency/sub-agency name is to facilitate proper identification and communication between agencies and involved parties, ensuring transparency, accountability, and effective management of services or cases being referred.

What information must be reported on referring agency/sub-agency name?

The information that must be reported includes the official name of the agency, the nature of the referral, any relevant case numbers, identifying contacts, and any pertinent data related to the type of services provided or requested.

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