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Complete Section B if you are a FACILITY PROVIDER (facilities include the following provider types; 01, 02, 03, 05, 46, 89, 90, 92, 93, 94) enrolling to provide services for one of the Department
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What is Check the appropriate application type:New EnrollmentRe-Enrollmentor Update Form?

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Check form appropriate application is a form used to request approval for a check payment.
Anyone who is making a check payment that requires approval must file the check form appropriate application.
The check form appropriate application can be filled out by providing details about the check payment and obtaining the necessary signatures for approval.
The purpose of the check form appropriate application is to ensure that all check payments are approved and authorized before being processed.
The check form appropriate application must include details about the payee, amount, purpose of the payment, and any other relevant information.
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