Get the free DOA-150 Provider Agency Information Form - ncdhhs
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This form is used by provider agencies to supply necessary information each year for the Aging Resources Management System (ARMS) regarding services provided, agency details, and contract information.
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How to fill out doa-150 provider agency information
How to fill out DOA-150 Provider Agency Information Form
01
Obtain the DOA-150 Provider Agency Information Form from the appropriate regulatory body or website.
02
Fill out the 'Agency Name' field with the official name of your provider agency.
03
Enter the 'Agency Address' including street, city, state, and ZIP code.
04
Provide the 'Contact Person's Name' who will serve as a primary point of contact.
05
List the 'Contact Person's Phone Number' and 'Email Address' for communication purposes.
06
Indicate the 'Type of Agency' by checking the appropriate box (e.g., nonprofit, for-profit).
07
Fill out the 'Services Provided' section with a brief description of the services your agency offers.
08
Include the 'Tax Identification Number' (TIN) or Employer Identification Number (EIN) of your agency.
09
Review the completed form for accuracy and ensure all fields are filled out appropriately.
10
Sign and date the form before submission.
Who needs DOA-150 Provider Agency Information Form?
01
Organizations or individuals applying to provide services under state-funded programs.
02
Agencies looking to formalize their status with regulatory bodies.
03
Providers seeking reimbursement for services from government programs.
04
Any entity involved in the delivery of care or services that require state oversight.
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What is DOA-150 Provider Agency Information Form?
The DOA-150 Provider Agency Information Form is a document used by provider agencies to submit their information to the Department of Aging.
Who is required to file DOA-150 Provider Agency Information Form?
Provider agencies that receive funding or services from the Department of Aging are required to file the DOA-150 form.
How to fill out DOA-150 Provider Agency Information Form?
To fill out the DOA-150 form, providers must complete the required sections with accurate information regarding their agency, services offered, and contact details, then submit it to the appropriate department.
What is the purpose of DOA-150 Provider Agency Information Form?
The purpose of the DOA-150 form is to collect necessary information about provider agencies to ensure proper funding and effective communication between the agencies and the Department of Aging.
What information must be reported on DOA-150 Provider Agency Information Form?
The DOA-150 form must report information such as agency name, address, contact information, services provided, and financial information related to the agency's operation.
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