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THM PARENT ASSOCIATION Check Requisition Formatted all receipts to upper right corner of this form Requested by: Date: / / TOTAL REQUESTED: $ (use separate forms for unrelated claims) Reason for reimbursement
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hthm pa checkrequisitionform2018docx is a document used for processing check requisitions within the Pennsylvania Health and Human Services departments, specifically for the year 2018.
Entities or individuals receiving payments from Pennsylvania's Health and Human Services programs are required to file hthm pa checkrequisitionform2018docx.
To fill out hthm pa checkrequisitionform2018docx, complete the required fields with accurate information regarding the payment request, including details like payee information, payment amount, and reason for the request, then submit it as per agency instructions.
The purpose of hthm pa checkrequisitionform2018docx is to formalize requests for payment and ensure that funds are allocated correctly within the Pennsylvania Health and Human Services programs.
The form must report the payee's name, address, taxpayer identification number, amount requested, purpose of the payment, and any relevant codes or references associating the request to specific programs or services.
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