Edit, Download, and Sign the Walmart USERRA Settlement Claim Form Instructions
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How do I fill this out?
Filling out this claim form is essential for eligibility. Start by gathering your personal details and employment information. Carefully follow all sections to ensure a valid submission.
How to fill out the Walmart USERRA Settlement Claim Form Instructions?
1
Read the eligibility criteria and instructions.
2
Complete each section of the form fully.
3
Provide accurate employment and military service details.
4
Sign and date the form.
5
Submit the completed form by the deadline.
Who needs the Walmart USERRA Settlement Claim Form Instructions?
1
Walmart employees who took military leave between October 10, 2004 and December 31, 2020.
2
Individuals wanting to claim benefits from the USERRA settlement.
3
Former Walmart employees seeking compensation for military service interruptions.
4
Military reservists who worked at Walmart during the eligible timeframe.
5
Anyone needing clarification on their eligibility for the settlement.
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1
Upload the Walmart claim form to PrintFriendly.
2
Use the editing tools to input your information.
3
Correct any errors found within the document.
4
Review the changes to ensure accuracy.
5
Save your changes and prepare for submission.
What are the instructions for submitting this form?
To submit your claim form, visit www.WalmartUSERRASettlement.com for online submissions. You can also mail it physically to: Walmart USERRA Settlement, c/o RG/2 Claims Administration LLC, P.O. Box 59479, Philadelphia, PA 19102-9479. Ensure that your submission is postmarked by September 16, 2021, to be considered valid.
What are the important dates for this form in 2024 and 2025?
Key dates for the claim process include September 16, 2021, the deadline for submission. Review your eligibility well before this date to ensure all paperwork is ready.
What is the purpose of this form?
The purpose of this form is to allow eligible Walmart employees to claim benefits associated with their military leave. It acts as an official means of recording employment and military service details for those who took short-term military leave. Completing this form correctly is vital for securing the benefits you may deserve under the USERRA settlement.
Tell me about this form and its components and fields line-by-line.
- 1. Name: Your full name including first, middle, and last.
- 2. Email: A valid email address for communication.
- 3. Phone: Mobile or home phone number.
- 4. Address: Your street address including apartment number.
- 5. City: Your city of residence.
- 6. State: The state you reside in.
- 7. Zip Code: Your postal zip code.
- 8. Walmart Identification Number: Your WIN Number if known.
- 9. Date of Birth: Your birth date in MM/DD/YYYY format.
- 10. Social Security Number: Your full Social Security Number.
What happens if I fail to submit this form?
Failing to submit the claim form by the deadline results in ineligibility for benefits. Be sure to complete all sections carefully to avoid issues during processing.
- Late Submission: Submitting the form after the deadline will disqualify you from receiving benefits.
- Incomplete Information: Not providing all required details can lead to claim denial.
- Wrong Submission Method: Failure to submit through the correct channel may void your claim.
How do I know when to use this form?
- 1. To Claim Benefits: Use this form when seeking compensation for military leave.
- 2. For Employment Verification: Your employment at Walmart during your leave period needs to be confirmed.
- 3. To Complete Legal Obligations: Required for fulfilling legal documentation regarding military service.
Frequently Asked Questions
Who is eligible to submit this claim form?
Employees of Walmart who took short-term military leave during the specified time frame are eligible.
What is the deadline for submission?
The claim form must be submitted by September 16, 2021.
How do I submit the claim form?
Submit online at www.WalmartUSERRASettlement.com or mail it to the Claims Administrator.
Can I submit more than one claim?
Each class member may only submit one claim form.
What do I do if I didn’t receive the Notice Packet?
You must submit proof of your military service along with your claim.
Is there a way to track my claim?
You can contact the Claims Administrator for updates on your claim.
What information is required on the claim form?
You need to provide personal information, employment history, and military service details.
Can I edit the form after submission?
No, once submitted, the claim cannot be altered.
What happens if my claim is late?
Late claims will not be accepted and leave you ineligible for benefits.
How will I receive my payment if my claim is approved?
Payments will be mailed to the address provided on your claim form.
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