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Section 05, Attachment C1 form page i of ii NONMEDICAL MENTAL HEALTH OUTPATIENT BENEFIT REQUEST (Form for Agencies with a Quarterly Allocation) Date Requested: Client Name: ACID: Case Rate Requested:

How to fill out section 05 attachment c-1

How to fill out section 05 attachment c-1

1. To fill out section 05 attachment c-1, follow these steps:
2. Start by reading the instructions provided for section 05 attachment c-1. Make sure you understand the purpose of this section and what information is required.
3. Gather all the necessary documents and information that you will need to complete this section. This may include previous financial records, tax forms, or other supporting documents.
4. Carefully review each question or field in section 05 attachment c-1. Fill in the required information accurately and thoroughly.
5. Double-check your entries to ensure that there are no mistakes or missing information. Use the provided guidelines or examples if needed.
6. If any supporting documents are required, make sure to attach them as specified. Follow the given format or instructions for attaching additional files.
7. Once you have completed filling out section 05 attachment c-1, review your answers one final time for accuracy and completeness.
8. Sign and date the section as required. If there are any additional instructions regarding submission or submission method, follow them accordingly.
9. Keep a copy of the filled-out section 05 attachment c-1 and any supporting documents for your records. Submit the original as instructed.
10. If you have any doubts or questions, contact the appropriate authority or person responsible for the form or application.
11. Remember to follow the specific guidelines and requirements provided for section 05 attachment c-1 to ensure your submission is complete and accurate.

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