Templates
Sample Letters
Copyable templates. Fill in the bracketed sections with your own facts, and send by certified mail with return receipt requested so you have proof of what was sent and when.
Debt Validation Request
This is a general template. Fill in your own facts carefully, and consider having it reviewed by an attorney or legal aid organization before sending, especially for larger debts. Invokes: 15 U.S.C. §1692g.
[Your Name]
[Your Address]
[City, State, ZIP]
[Date]
[Collector Name]
[Collector Address]
Re: Account Number [account number, if known]
To Whom It May Concern:
I am writing in response to your communication dated [date of their letter/call] regarding the above-referenced account. I dispute this debt and am requesting validation under 15 U.S.C. §1692g.
Please provide the following:
- The amount of the debt
- The name of the original creditor
- Verification that this debt is valid and that I am obligated to pay it
Under federal law, you must cease all collection activity on this account until you provide this validation. Please do not contact me by telephone; all further communication should be in writing to the address above.
Sincerely,
[Your signature]
[Your printed name]
Cease Communication Request
This is a general template. Sending this stops most further contact, but it does not erase the debt or prevent a lawsuit. Invokes: 15 U.S.C. §1692c(c).
[Your Name]
[Your Address]
[City, State, ZIP]
[Date]
[Collector Name]
[Collector Address]
Re: Account Number [account number, if known]
To Whom It May Concern:
Under 15 U.S.C. §1692c(c), I am requesting that you cease all further communication with me regarding the above-referenced account, except as permitted by law (such as to notify me of specific actions you intend to take).
Please direct any further written communication to the address above.
Sincerely,
[Your signature]
[Your printed name]
Texas — Medical Debt Timely-Billing Dispute
Use only if your gap between date of service and date the claim was filed with insurance exceeds 11 months (or your insurer's contractual deadline, if shorter). See the Medical Debt page for details. Invokes: Tex. Civ. Prac. & Rem. Code §§146.002–146.003.
[Your Name]
[Your Address]
[City, State, ZIP]
[Date]
[Collector or Provider Name]
[Address]
Re: Account Number [account number]
To Whom It May Concern:
I am disputing the above-referenced medical debt under Texas Civil Practice and Remedies Code §§146.002–146.003.
Date of service: [date]
Date claim was filed with insurer: [date, if known]
Under §146.002, a health care provider must bill a patient's insurer no later than the first day of the 11th month after the date services were provided, unless an earlier deadline applies by contract. Under §146.003, a provider who misses this deadline may not recover from the patient any amount that would have been covered by insurance had the provider billed on time.
Based on the dates above, I believe this deadline was missed. Please provide documentation of the date this claim was filed with my insurer, and confirm this account will be closed as legally barred under §146.003.
Sincerely,
[Your signature]
[Your printed name]