Form IHS-961 Agreement to Assign Claim Upon Request

What Is Form IHS-961?

This is a legal form that was released by the U.S. Department of Health and Human Services - Indian Health Service on November 1, 2021 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form IHS-961 Agreement to Assign Claim Upon Request?
A: Form IHS-961 is a legal document used to transfer or assign a claim upon request.

Q: Who uses Form IHS-961 Agreement to Assign Claim Upon Request?
A: This form is typically used by individuals or organizations who want to transfer their claim to another party.

Q: What is the purpose of using Form IHS-961 Agreement to Assign Claim Upon Request?
A: The purpose of this form is to establish a legal agreement between the claim holder and the assignee, allowing the assignee to take over the rights and benefits of the claim.

Q: How do I fill out Form IHS-961 Agreement to Assign Claim Upon Request?
A: The form requires basic information about the claim holder, the assignee, and details of the claim. It is important to provide accurate and complete information to avoid any complications.

Q: What should I do with the completed Form IHS-961 Agreement to Assign Claim Upon Request?
A: Once the form is completed, it should be signed by both the claim holder and the assignee, and a copy should be kept for your records. It may be necessary to submit the form to the relevant authority or the party responsible for handling the claim.