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PPL Service Authorization For Illinois DD Home Based Support Services Participant Directed Program Fax Service Authorizations to 866 826 7287 Check one New Participant Current Participant Auth Change Waiver Type Adult Child Participant Name Participant s RIN Participant s Medicaid ID Start Date Required / / End Date PSW Name1 PPL ID Code 55D Hourly Pay Rate Billable REQUIRED ITEMS Include RIN Include Medicaid ID Waiver Type Hourly Billable Rate Signed and...
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What is startdaterequired?
startdaterequired is the date required to be filled out by individuals or entities.
Who is required to file startdaterequired?
Any individual or entity that is specified by the governing body to provide the startdaterequired.
How to fill out startdaterequired?
startdaterequired can be filled out by entering the specific date or information requested by the governing body.
What is the purpose of startdaterequired?
The purpose of startdaterequired is to gather specific information or data from individuals or entities for regulatory or compliance purposes.
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The information required to be reported on startdaterequired may vary depending on the specific requirements set by the governing body.
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