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U.S. Department of Health and Human Services
Indian Health Manual

Part 9, Chapter 4: Manual Exhibit 9-4-A

Sample First Demand Letter


(Date)

(Name)
(Address)

RE:  (Bill Number) Your account is 30 days overdue.

Dear Mr./Ms. (Last Name)

(Explain the nature and amount of the debt, including the basis for the indebtedness.)

The following are your rights:

  1. An opportunity to inspect and copy your debt records.
  2. An opportunity for a review within the Indian Health Service of the basis/validity of the debt and for purposes of administrative wage garnishment or salary offset, to request a hearing.
  3. An opportunity to present evidence that all or part of the debt is not past due or legally enforceable.
  4. An opportunity provided to enter into a written repayment agreement.

In order to preserve these rights, please respond in writing within 30 days of this letter date and indicate which right you would like to exercise.  Or you may pay the debt in full, within 30 days of the date above, to avoid imposition of interest, administrative fees, penalties, administrative offset, reporting to credit bureaus, collection agencies, administrative wage garnishment, and/or litigation.  Referring debt to the Department of the Treasury is mandatory if the debt is delinquent 180 days or greater.  The applicable standards for imposing interest, penalties, or administrative costs are found in 45 Code of Federal Regulations, Part 30.18.

Thank you for your payment.

(Employee Name, Claims Collection Officer, Phone number)