UHG Hardship Request Process Ver 1.0

1
Submission Date & Time
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Agency Name or Law Firm Name* This field is required.
3
Email* This field is required.This is the email your decision will be delivered to.
example@example.com
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UHG Account ID (Data ID)* This field is required.Exactly as it appears in the placement file from Beam or Debt Next. You MAY NOT use the issuer account ID.
5
Types of Hardships:

A temporary hardship situation is transient in nature and has an expected end date, which include, but are not limited to a medical emergency, a natural disaster, a national pandemic or similar situation.

A permanent hardship situation does not have an expected end date and the situation is unlikely to change, which include, but are not limited to: a terminal illness, permanent disability (with documentation provided for records), or similar situation.
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Type of Hardship Being Requested* This field is required.
Temporary Hardship
Permanent Hardship
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Temporary Hardship Reason
Medical related issues/Hospitalization
Disaster/Natural Disaster/Pandemic
Other
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Permanent Hardship Reason
Permanent Disability (with documentation provided for records)
Terminal illness
Other
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Upload DocumentationYou can upload multiple files.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Service Provider Notes* This field is required.Provide any additional details that may help our team make the best informed decision possible for the consumer.
The more details that you provide will assist us in making a decision as soon as possible. .
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UHG Comments-Internal
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Ok
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Get Page URL
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