(a) the information described in section 2811.2, subdivisions (a) through (h) and, if applicable, subdivisions (l) and (m);

(b) a certification that the claimant meets all applicable eligibility requirements set forth in section 2811 of this chapter;

(c) a certified or verified copy of the judgment, court-approved settlement, or arbitration award pursuant to which the claimant seeks reimbursement;

(d) an agreement by the claimant that the Board may conduct an audit of any claim honored by the Board and that the claimant will reimburse the Board for any disallowance of costs occasioned by such an audit. The claimant must also agree to retain all records pertaining to the claim for a period of at least three years after final payment on the claim, and to provide the records to the Board upon request. The three-year period shall be extended until the completion of any audit in progress.

(e) any other information or supporting documentation reasonably required by the Division to determine the eligibility, reimbursable amount due, and appropriate priority class of the claim.