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Name of Fiscal Intermediary MMIS Medicaid ID Date Signature Name Please Print Title Please Print Please note that in accordance with Parts 86-1. Attachment A-5 NEW YORK STATE DEPARTMENT OF HEALTH OFFICE OF HEALTH INSURANCE PROGRAMS FISCAL INTERMEDIARY FOR CONSUMER DIRECTED PERSONAL ASSISTANCE SERVICES Quarterly Certification of Compliance with Home Care Worker Wage Parity I hereby certify that services provided by my organization for the period July 1 2017 and subsequent are in full...
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What is attachment a-5?
Attachment A-5 is a form used to report additional information related to income tax filings.
Who is required to file attachment a-5?
Individuals or businesses who have specific income types or transactions that need to be reported must file attachment A-5.
How to fill out attachment a-5?
Attachment A-5 can be filled out by entering the required information in the designated fields on the form.
What is the purpose of attachment a-5?
The purpose of attachment A-5 is to provide additional details and clarification on certain income items or transactions for tax reporting purposes.
What information must be reported on attachment a-5?
Information such as specific income types, transactions, or adjustments that are not captured on the main tax form must be reported on attachment A-5.
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