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MAP377 (Rev. 11/20)PHYSICIANS CERTIFICATION FOR MEDICAID HOSPICE BENEFIT RECERTIFICATION STATEMENT FOR 90/60-DAY PERIOD RECIPIENT INFORMATION Recipient Name: Medicaid ID Number: or Social Security
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NJAC 1054 is a regulatory form used in the state of New Jersey for compliance and reporting purposes, specifically related to environmental and public health regulations.
Entities that are involved in activities subject to New Jersey's environmental regulations, such as businesses in certain industries, are required to file NJAC 1054.
To fill out NJAC 1054, follow the instructions provided in the form, ensuring all required fields are completed accurately and submitting any necessary supporting documents as specified.
The purpose of NJAC 1054 is to collect necessary data for regulatory oversight, compliance monitoring, and ensuring public health and safety with respect to environmental regulations.
Information that must be reported on NJAC 1054 includes details regarding the entity's operations, environmental impact, compliance status, and any relevant incident reports or data.
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