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INSTRUCTIONS FOR THE 20162017 ADULT CARE COST REPORTS AND REVENUE REPORTING SYSTEM For Facilities Providing Services to Recipients of State/County Special Assistance for AdultsCAPACITY OF 7 LICENSE

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How to fill out service report state-county special

01

Open the service report form

02

Locate the section for state and county information

03

Fill in the name of the state where the service is being provided

04

Enter the name of the county where the service is being provided

05

If there are multiple counties involved, enter all the county names separated by commas

06

Double-check and verify the accuracy of the entered state and county information

07

Save the filled-out service report

Who needs service report state-county special?

01

Service providers who need to document the specific state and county where a service is provided

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What is service report state-county special?

The service report state-county special is a specific report that must be filed detailing services provided in a specific state or county.

Who is required to file service report state-county special?

Any individual or business that provides services in a specific state or county is required to file the service report state-county special.

How to fill out service report state-county special?

To fill out the service report state-county special, you will need to provide details on the services provided, including dates, locations, and any relevant information.

What is the purpose of service report state-county special?

The purpose of the service report state-county special is to track and monitor services provided in a specific state or county for regulatory and compliance purposes.

What information must be reported on service report state-county special?

The service report state-county special must include details on the services provided, dates of service, locations, and any other relevant information.

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