UHG Law Office Request Process Ver 1.0

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Please note, this form is NOT used to request a hardship or report a counterclaim.

Counterclaims are reported through IPACS (click this link).

Hardships are reported through our HELP APP (click this link) and select the hardship option.

**Your Firm already has authority up to 85% on all accounts. Only submit this Form for requests for less than 84% of the balance.**
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Submission Date & Time
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Law Firm Name* This field is required.
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Email* This field is required.
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 Debt Next. You MAY NOT use the issuer/original creditor account ID.
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Portfolio ID* This field is required.Exactly as outsourced by UHG
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Consumer's State* This field is required.Current state of residence
select a state
select a state
Alabama - AL
Alaska - AK
American Samoa - AS
Arizona - AZ
Arkansas - AR
California - CA
Colorado - CO
Connecticut - CT
Delaware - DE
District of Columbia - DC
Federated States of Micronesia - FM
Florida - FL
Georgia - GA
Guam - GU
Hawaii - HI
Idaho - ID
Illinois - IL
Indiana - IN
Iowa - IA
Kansas - KS
Kentucky - KY
Louisiana - LA
Maine - ME
Marshall Islands - MH
Maryland - MD
Massachusetts - MA
Michigan - MI
Minnesota - MN
Mississippi - MS
Missouri - MO
Montana - MT
Nebraska - NE
Nevada - NV
New Hampshire - NH
New Jersey - NJ
New Mexico - NM
New York - NY
North Carolina - NC
North Dakota - ND
Northern Mariana Islands - MP
Ohio - OH
Oklahoma - OK
Oregon - OR
Palau - PW
Pennsylvania - PA
Puerto Rico - PR
Rhode Island - RI
South Carolina - SC
South Dakota - SD
Tennessee - TN
Texas - TX
Utah - UT
Vermont - VT
Virgin Islands - VI
Virginia - VA
Washington - WA
West Virginia - WV
Wisconsin - WI
Wyoming - WY
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Consumer's Age* This field is required.Current Age of Consumer
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Charge-Off Date* This field is required.Select "Set" to enter date.
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Last Pay Date* This field is required.Select "Set" to enter date.
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Current Balance* This field is required.
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Original Balance* This field is required.
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Please choose your requested approval from the list below:* This field is required.You may only choose one
Additional SIF Request below Approved 85% of the balance
Mutual Walkaway/Full Settlement Release
Request for Payout by UHG to Consumer/Consumer Attorney
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Additional SIF Request below Approved 85% of the balancePlease provide total settlement amount proposed INCLUDING your firm legal fees)
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SIF Percentage
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Are there multiple payments* This field is required.
YESNO
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If multiple payments, how many?Including the first payment
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Settlement Payment Date* This field is required.Please provide settlement payment date (if multiple this is the first date)
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Opposing Counsel Name or enter “pro se"
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Requester's NotesTHIS IS WHERE YOU STATE WHY YOU NEED THIS SETTLEMENT All settlements below your allowable authority requires UHG authorization. All settlements are subject to audit. If you cannot provide evidence of an approved SIF request, your Firm will be responsible for the difference in any unauthorized settlement.
Explain why you are requesting this settlement.
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Detailed Reason UHG should accept Walkaway/Full release (Example: represented by legal aid, opposing counsel regularly demands fees, must have original creditor witness for success at trial, etc.)
Explain why you are requesting this settlement.
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Detailed explanation of what is the RISK to UHG if not accepted (Example: Opposing counsel routinely successful in defending/previous experiences, UHG would be responsible for fees, probable arbitration costs, filing of counterclaims imminent, etc.)
Explain why you are requesting this settlement.
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UHG Comments-Internal
Huge
Large
Normal
Small
Ok
Ok
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Get Page URL
Should be Empty: