From RECP Form, 2021
Part 11: PREVIOUS PAYMENTS OF MONEY.
Please answer the following question:
Have you or anyone else received any payment of money pursuant to final award or settlement on a claim (other than a claim for worker’s compensation) against any person (or corporation), that is based on the illness for which this claim is submitted?
YES [ ] NO [ ]
If you checked "YES," please use a separate sheet of paper to identify the date, amount, and person or organization from whom EACH AND EVERY payment of money was received, and explain the circumstances surrounding the payment.