_pages/claims/step-2.html
---
title: File a Claim
---
{% include head.html %}
<link href="{{site.baseurl}}/stylesheets/form.css" type="text/css" rel="stylesheet" />
<body class="no-js layout-claims layout-claims-verify">
<a class="a-skip-to-main" href="#main">Skip to main content</a>
{% include site-header.html %}
<main role="main" id="main" class="page">
<div class="wrapper">
<h1>File a claim, step 2: healthcare verification</h1>
<p>Your information was successfully submitted. Please provide the claimant’s healthcare provider with their last name and the following verification code:</p>
<span class="claim-verification-code">012439</span>
<p>For more information, ask them to visit <a href="{{site.baseurl}}/healthcare-providers/">the healthcare providers page</a> of this site. We’ll begin processing your claim as soon as we hear from your healthcare provider.</p>
<section class="claim page">
<h1>Claim #123456</h1>
<a href="#" class="button">Download</a>
<section>
<h1>Claim information</h1>
<dl>
<dt>Reason for claim</dt>
<dd>Bond with a newboard or newly adopted child.</dd>
<dt>Claim start date</dt>
<dd>09/29/2017</dd>
</dl>
</section>
<section>
<h1>Person claiming benefits</h1>
<dl>
<dt>Name</dt>
<dd>
<dl>
<dt>First</dt>
<dd>Jonathan</dd>
<dt>Middle</dt>
<dd>Dalton</dd>
<dt>Last</dt>
<dd>Wilson</dd>
</dl>
</dd>
<dt>Mailing address</dt>
<dd>
<dl>
<dt>Street address</dt>
<dd>123 Market St.</dd>
<dt>City</dt>
<dd>Springfield</dd>
<dt>State</dt>
<dd>ST</dd>
<dt>Postal code</dt>
<dd>20210</dd>
</dl>
</dd>
</dl>
</section>
</section>
</div>
</main>
{% include site-footer.html %}
</body>