Submit Claim
| Instructions: |
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The deadline to submit a claim was 11:59 PM (Pacific Standard Time) on November 23, 2022. You should NOT submit both an online claim AND a paper form. Only one Claim form will be accepted per qualified individual.
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For more information or issues regarding filing a claim, please contact the Administrator at:
| By Mail | By Phone | By Email |
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PCS Revenue Control Systems |
(800) 842-4612 | [email protected] |