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DEPARTMENT OF HEALTH SERVICES Division of Long Term Care F-22637 (07/2008) STATE OF WISCONSIN 42 CFR 431 INTERAGENCY NOTIFICATION TERMINATION OF COMMUNITY WAIVER PARTICIPATION This form is to be completed
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How to fill out interagency notification termination of
How to fill out Interagency Notification Termination of:
01
Gather all the necessary information and documentation required for the termination process.
02
Carefully read and understand the instructions provided with the Interagency Notification Termination form.
03
Fill out the form accurately, providing all the requested information such as contact details, agency name, and termination date.
04
Attach any supporting documents or evidence that might be required to justify the termination.
05
Review the completed form to ensure all the information provided is correct and accurate.
06
Sign and date the form, as required.
07
Submit the completed Interagency Notification Termination form to the appropriate authority or agency.
Who needs Interagency Notification Termination of:
01
Individuals or entities who want to terminate their interagency notifications.
02
Agencies or organizations that have been notified of any interagency collaboration or agreement and now wish to terminate it.
03
Parties who have concluded their joint project, partnership, or agreement and no longer require the interagency notification.
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What is interagency notification termination of?
Interagency notification termination refers to the process of informing multiple agencies or departments of the termination of a specific activity or project.
Who is required to file interagency notification termination of?
The entity or organization responsible for the activity or project is required to file the interagency notification termination.
How to fill out interagency notification termination of?
To fill out the interagency notification termination, the responsible entity needs to provide information about the terminated activity or project, including relevant dates, reasons, and any required documentation.
What is the purpose of interagency notification termination of?
The purpose of the interagency notification termination is to ensure that all relevant agencies or departments are informed about the termination of a specific activity or project. This allows them to update their records or take any necessary actions.
What information must be reported on interagency notification termination of?
The interagency notification termination must include information such as the name of the terminated activity or project, the responsible entity, termination date, reasons for termination, and any documentation required by the agencies or departments.
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