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RepresentativeInformation [USM]

Representative Information [USM]

Representative Information is as follows. The required information is bold.

  • RepLastName
  • RepFirstName
  • RepMI
  • RepSuffix
  • Complete Rep Address
  • RepRelationship
    • valid relationship values (choose only one)
      • Guardian/Admin
      • Other
      • Relative

A Representative is only required if the Claimant is deceased.

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