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Provider Contact Form Please type information or print Executive Director Provider Name: Name: Address Line 1: Title: Degree: Line 2: Phone no.: City: State: Position: Ext.: E-mail Address: Zip: County:
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What is nys omh contract form?
The NYS OMH contract form is a standardized contract that is used by the New York State Office of Mental Health (OMH) to enter into agreements with providers of mental health services.
Who is required to file nys omh contract form?
Providers of mental health services who wish to receive funding from the New York State Office of Mental Health (OMH) are required to file the NYS OMH contract form.
How to fill out nys omh contract form?
To fill out the NYS OMH contract form, providers need to provide all required information and accurately complete each section of the form. They should carefully review the instructions provided by the OMH to ensure proper completion.
What is the purpose of nys omh contract form?
The purpose of the NYS OMH contract form is to establish a contractual agreement between the New York State Office of Mental Health (OMH) and providers of mental health services. It outlines the terms, conditions, and obligations of both parties involved.
What information must be reported on nys omh contract form?
The NYS OMH contract form requires providers to report various information, including their organization's name and contact information, program description, services to be provided, budget details, staffing information, performance measures, and compliance with applicable laws and regulations.
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