Get the free I, (Name of Custodian), hereby certify the following to be true and correct:
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I am employed/contracted by Name of User as a n occupation/description. II. Pursuant to the attached Data Use Agreement DUA between the DEPARTMENT OF HEALTH CARE SERVICES DHCS and Name/NPI of User I received and acted as custodian of the data described in Attachment A of the DUA. The purpose for receiving some of the data described in Attachment A has been met. That data is specified as follows IV. ATTACHMENT E DEPARTMENT OF HEALTH CARE SERVICES CERTIFICATE OF DESTRUCTION OF CONFIDENTIAL...
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What is the name of custodian?
The name of the custodian is the individual or entity responsible for managing the assets in a custodial account.
Who is required to file the name of custodian?
The name of custodian is typically required to be reported by the account holder or the entity overseeing the custodial account.
How to fill out the name of custodian?
The name of custodian can usually be filled out on the account opening forms or through an online account management system provided by the financial institution.
What is the purpose of the name of custodian?
The purpose of the name of custodian is to identify who is responsible for managing the assets in the custodial account.
What information must be reported on the name of custodian?
The name, contact information, and relationship to the account holder of the custodian must be reported.
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