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Section 05, Attachment C2 form page i of ii NONMEDICAL OUTPATIENT BENEFIT REQUEST (Form for Agencies without a Quarterly Allocation) Date Requested: Client Name: ACID: Case Rate Requested: Provider

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What is section 05 attachment c-2?

Section 05 attachment c-2 is a specific document that must be filed with certain financial reports.

Who is required to file section 05 attachment c-2?

Entities or individuals meeting certain criteria as outlined in the regulations.

How to fill out section 05 attachment c-2?

Section 05 attachment c-2 must be filled out accurately and completely following the instructions provided.

What is the purpose of section 05 attachment c-2?

The purpose of section 05 attachment c-2 is to provide additional information or details related to the main financial report.

What information must be reported on section 05 attachment c-2?

Specific information or data as required by the regulating body.

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