Oregon.gov : Client Maintenance Unit Request

Confirmation Number:

Date Received:

Your submission has been received. If you wish to print a detailed summary of your submission, please click "PRINT OR SAVE" for a printable version.

Urgent requests will be processed within one business day. Please allow up to five business days for processing all non-urgent requests.

If you have questions about your submission, please contact CMU at 503-378-4369.

Please note that you will not be able to print or save the detailed summary after you leave this page.

Confirmation Id:

Date Received:

Step 1. Enter Worker Contact Information

Please enter your contact information below.

First Name	Last Name	Branch or Office	Email Address	Your Supervisor’s Email Address	Phone Number
					Ext.

No other information needed for request.

Step 3. Additional Information

File attachments (Optional)

You may upload multiple files by clicking in the white box below.

Step 4. Urgent Processing

Check this box only if urgent processing is needed because the client has been denied medications or emergency treatment or has no current coverage and needs immediate access to benefits or services.

Additional Information

General Comments

File attachment

No files attached to submission.

Document name

Urgent Processing

Urgent Processing: Yes No

Reason: -

Submission Review Submission Sent!

EDIT Step 1. Enter Worker Contact Information