Get the free Exhibit C1: Title XX Certification of Proper Billing (DODD 1014-2) - doddportal dodd...

Social Security Number/Unique Identifier MM/DD/YY // 3. Street Address 2. Eligibility verified from CBDD based upon 4. You may copy Section H to add space for additional redeterminations. B. Individual Eligibility for CBDD Services A. Title XX Service Service Code Does the service align with the ISP or IFSP Yes Additional Comments If Needed No If No then Title XX cannot be billed for this service. Longer included in the Grant Agreement. no longer eligible for county board source is being...

How to fill out exhibit c1 title xx

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