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STATE OF OHIO OFFICE OF BUDGET & MANAGEMENT 30 E. BROAD STREET, 34TH FLOOR COLUMBUS, OHIO 43215-3457 AUTHORIZATION AGREEMENT FOR STATE MEDICAID PAYMENTS To APPLY for EFT, to CHANGE bank information
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How to fill out a fax transmittal cover sheet:

01
Start by placing your company's name and contact information at the top of the cover sheet. Include the company's name, address, phone number, and fax number.
02
Next, indicate the recipient's name, company, and contact information below your own. Include the recipient's name, company name, address, phone number, and fax number.
03
Write down the date of transmission. This shows the recipient when the fax was sent.
04
In the "Subject" or "Re" field, briefly describe the purpose of the fax. This helps the recipient understand the content of the fax.
05
If necessary, include any reference or account numbers in a designated field. This can be useful for internal tracking or when referencing previous communications.
06
Provide a brief message or cover letter to accompany the fax. This can include any necessary additional information or instructions for the recipient.
07
Finally, sign your name and include your title or position in the designated signature field.

Who needs a fax transmittal cover sheet?

01
Businesses and organizations: Many businesses still rely on fax machines for transmitting important documents. Using a fax transmittal cover sheet ensures that the recipient receives all the necessary information and understands the purpose of the fax.
02
Medical and legal professionals: Faxing sensitive and confidential information, such as medical records or legal documents, is common in these professions. Including a cover sheet helps maintain confidentiality and provides essential details to the recipient.
03
Government agencies: Government agencies often require specific documentation to be faxed for various purposes. A fax transmittal cover sheet ensures that the proper information is transmitted to the correct department or individual.
04
Individuals: Although email and other electronic communication methods are more prevalent nowadays, some individuals may still need to fax documents for personal reasons, such as sending contracts, resumes, or legal paperwork. Using a fax transmittal cover sheet helps ensure that the recipient understands the nature and importance of the faxed documents.
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