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220 Burnham Street South Windsor, CT 06074 Fax 6153406107 NEW YORK MEDICAID DENTAL ELECTRONIC CLAIMS ENROLLMENT REGISTRATION PAYER ID NUMBERCKNY1(to be used ONLY by Dental Offices whose category of

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How to fill out to be used only

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2. Read the instructions provided with the form to understand the requirements and guidelines.
3. Begin filling out the form by entering your personal information, such as your name, address, and contact details.
4. Follow the prompts on the form to provide the required information in an organized manner.
5. Double-check your entries and make sure all the information provided is accurate and up-to-date.
6. If there are any sections or questions that you are unsure about, seek clarification or assistance from the relevant authority or agency.
7. Complete any additional sections or attachments as specified by the form's instructions.
8. Review the completed form once again to ensure nothing has been missed or overlooked.
9. Sign and date the form where required, and provide any supporting documentation as necessary.
10. Make a copy of the filled-out form and keep it for your records, and submit the original as instructed.

Who needs to be used only?

1. Anyone who is required to submit a specific form or application as per the instructions provided.
2. Individuals who need to provide their information, data, or details for legal, administrative, or official purposes.
3. Applicants who are seeking various types of approvals, permits, certifications, licenses, or registrations.
4. People who wish to apply for benefits, entitlements, grants, subsidies, or financial assistance.
5. Organizations or businesses that need to complete forms for compliance, reporting, or regulatory purposes.

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To be used only refers to a specific document or item that should not be shared or accessed by anyone else.

Who is required to file to be used only?

Anyone who has sensitive information that needs to be kept confidential may be required to use a 'to be used only' designation.

How to fill out to be used only?

To fill out a 'to be used only' designation, simply mark the document or item with the phrase 'to be used only' in a visible location.

What is the purpose of to be used only?

The purpose of 'to be used only' is to ensure the security and confidentiality of sensitive information.

What information must be reported on to be used only?

Any information that is considered confidential or sensitive should be reported on a 'to be used only' document or item.

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