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NEW YORK STATE DEPARTMENT OF HEALTH Office of Medicaid Management ATTACHMENT IIA NOTICE OF DECISION TO DISCONTINUE PARTICIPATION IN THE CARE AT HOME I AND II WAIVER PROGRAM NOTICE DATE: EFFECTIVE
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How to fill out notice of decision discontinue
How to fill out a notice of decision discontinuance?
01
Begin by gathering all the necessary information: Start by collecting the relevant details such as the case number, names of the parties involved, and specific dates related to the decision.
02
Clearly state the purpose: In the first paragraph, make it clear that you are filling out a notice of decision discontinuance. Specify the court or agency where the decision was made and provide any other relevant information.
03
Provide a brief summary: In the next section, briefly summarize the decision that you are discontinuing. Include key points such as the nature of the case and the initial outcome.
04
State the reasons for discontinuance: In a separate paragraph, clearly explain the reasons behind your decision to discontinue the previous decision. This may include a change in circumstances, settlement negotiations, or other valid reasons.
05
Sign and date the notice: At the bottom of the notice, include a space for your signature, printed name, and date. It is important to provide your contact information as well so that the court or agency can contact you if necessary.
Who needs a notice of decision discontinuance?
A notice of decision discontinuance is typically needed by individuals or parties involved in a legal or administrative process. It is commonly used when the original decision is no longer valid or applicable due to certain reasons. This may include situations where a settlement has been reached, new evidence has emerged, or there has been a change in circumstances that renders the previous decision ineffective.
By submitting a notice of decision discontinuance, you inform the relevant court or agency about your intention to withdraw or revoke the previous decision. This helps to ensure that all parties involved are informed and any relevant legal proceedings can be appropriately updated or closed.
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What is notice of decision discontinue?
The notice of decision discontinue is a formal notification that a decision or action will be discontinued.
Who is required to file notice of decision discontinue?
The party or individual who made the decision or took the action is generally required to file the notice of decision discontinue.
How to fill out notice of decision discontinue?
The notice of decision discontinue can usually be filled out online or on a specific form provided by the relevant authority. It typically requires information about the decision being discontinued and the reasons for the discontinuation.
What is the purpose of notice of decision discontinue?
The purpose of the notice of decision discontinue is to inform relevant parties and authorities that a decision or action will no longer be carried out.
What information must be reported on notice of decision discontinue?
The notice of decision discontinue usually requires information such as the decision being discontinued, the reasons for discontinuation, and any relevant dates or references.
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