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Page 1 of 20 EARLY INTERVENTION PROVIDER AGREEMENT, effective as of the date set forth on the signature page, is made between the City of New York, acting through the Commissioner (Commission r”)

How to fill out nyc ei provider agreement

1. First, gather all necessary information and documents. This may include your personal identification, contact information, and any relevant certifications or licenses required for being an Early Intervention (EI) provider in New York City.
2. Review the NYC EI Provider Agreement form thoroughly. Make sure you understand all the terms, conditions, and responsibilities outlined in the agreement. If there are any specific questions or concerns, seek clarification from the appropriate authorities or an attorney familiar with EI regulations.
3. Complete the required sections of the NYC EI Provider Agreement form. This may involve providing your legal name, business name (if applicable), address, phone number, and email address. Additionally, you may need to provide information related to your professional qualifications, such as your credentials, education, and experience.
4. Read any accompanying instructions or guidelines carefully and follow them to ensure accuracy and completeness in filling out the form.
5. If required, attach any supporting documents or certifications requested in the NYC EI Provider Agreement form. This may include copies of your professional licenses, insurance documentation, or other credentials as specified.
6. Review the completed NYC EI Provider Agreement form for any errors or omissions. Double-check that all sections have been properly filled out and all necessary information has been provided.
7. Sign and date the agreement where indicated. If there are additional signature lines for witnesses or notaries, make sure to complete those as well.
8. Make copies of the completed NYC EI Provider Agreement form and any accompanying documents for your records.

Who needs NYC EI Provider Agreement?

1. Any individual or entity seeking to become an Early Intervention (EI) provider in New York City.
2. Licensed professionals, such as speech therapists, occupational therapists, developmental specialists, psychologists, etc., who wish to provide services to children eligible for EI services in NYC.
3. Agencies or organizations that employ or contract with EI providers to deliver services to eligible children and their families in NYC.

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What is nyc ei provider agreement?

The NYC EI Provider Agreement is a contractual agreement between the New York City Early Intervention Program (NYC EI) and a provider that outlines the terms and conditions for providing services to eligible children and their families in the early intervention program.

Who is required to file nyc ei provider agreement?

All approved providers who wish to participate in the NYC EI program are required to file the NYC EI Provider Agreement.

How to fill out nyc ei provider agreement?

To fill out the NYC EI Provider Agreement, providers need to carefully review the agreement, complete all required fields, provide accurate information about their organization, services, and policies, and submit the agreement to the appropriate NYC EI agency for review and approval.

What is the purpose of nyc ei provider agreement?

The purpose of the NYC EI Provider Agreement is to establish a formal agreement between the NYC EI program and providers to ensure the delivery of high-quality early intervention services to eligible children and their families, and to outline the responsibilities and expectations of both parties.

What information must be reported on nyc ei provider agreement?

The NYC EI Provider Agreement typically requires providers to report information such as their organization's name, contact details, professional licenses, certification or accreditation, service areas, service rates, staffing qualifications, insurance coverage, compliance with regulations and policies, and agreement to follow NYC EI program guidelines and requirements.