About this form

This form is to be used to repay benefits overpaid by DCMWC as the result of death of the beneficiary or a change in the status of eligibility.

Please note that overpayment submissions should only be made if directed by DCMWC and the debtor has all information specific to the overpayment. Overpayment submissions without the valid information will be rejected.

Accepted Payment Methods:

• Bank account (ACH)
• Debit card

With an account you can:

• See the payments you made since you created an account.
• Store payment information so you don't have to re-enter it.
• Copy a form you already submitted the next time you need to make a payment.
• Set up automatic recurring payments.

To take advantage of these benefits, you can Sign In . If you don't have an existing account, you will have the option to create an account on the sign-in page. To continue as a guest user, click the 'Continue to the Form' button.