Statutory Claims To Pay Report
For the period: mm/dd/yyyy through mm/dd/yyyy
Contract: 123456 - Admin Unit: PORT - Status: ACTIVE
Name
SSN/Claim Number		 Disabled Benefits
Start		 Approved
Through		 Anticipated
Recovery		 Benefits Paid
To Date
FRANK JONES
xxx-00-1111 / 00010001		 mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy $1,018.40
Activity: END OF USUAL RECOVERY PERIOD
JOHN HUGHES
xxx-00-2222 / 00020002		 mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy $8,364.95
Activity: CLAIMANT EXPECTS TO RETURN TO WORK
LINDA JACKSON
xxx-00-3333 / 00030003		 mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy $5,085.47
Activity:
Notes:		 UPDATED MEDICAL NEEDED
EDC mm/dd/yyyy