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Agency or facility for example Hospital local DSS local Health Area Agency on Aging CSB State MH/MR facility CIL and below it in the 10 boxes provided that entity s 10 digit NPI/API number. If the Pre-Admission Screening is completed in the locality there should be two Level I screeners both the local DSS and local Health departments. Exceptions Authorizations for NF PACE AIDS or the EDCD Waivers are interchangeable. Screening updates are not required for individuals to move between these...
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Start by opening the recipient information form.
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Enter the recipient's full name in the designated space.
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Provide the recipient's address, including the street name, house number, city, state, and zip code.
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Recipient information includes details about the individual or entity who received payments or benefits.
The entity or individual who made the payments or provided the benefits is required to file recipient information.
Recipient information can be filled out by providing the recipient's name, address, tax identification number, and the amount of payments or benefits received.
The purpose of recipient information is to report payments or benefits made to individuals or entities for tax or regulatory purposes.
Recipient information must include the recipient's name, address, tax identification number, and the amount of payments or benefits received.
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