NH DHHS 301A free printable template

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STATE OF NEW HAMPSHIRE DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH SERVICES PLANNING AND REVIEW BOARD Form 301A Instructions Application for Exemption/Not Subject to Review NSR from the CON Process All persons who are requesting an exemption or NSR from the Certificate of Need CON process under the requirements of New Hampshire RSA Sections 151-C 5 and 151-C 13 must complete Form 301A except Transfers of Ownership. Transfers of Ownership requests must complete Form 301B. Form 301A consists...

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How to fill out NH DHHS 301A

01

Obtain the NH DHHS 301A form from the official NH DHHS website or your local health department.

02

Start by filling out the applicant's personal information, including name, address, and contact details.

03

Provide information about the household members by listing their names, ages, and relationships to the applicant.

04

Indicate the reason for completing the form by selecting the appropriate option or writing a brief explanation.

05

Fill in any relevant income information for the household, including sources and amounts.

06

Review the completed form for accuracy and ensure all required fields are filled out.

07

Sign and date the form at the designated section.

08

Submit the completed form as per the instructions provided, either online or by mail.

Who needs NH DHHS 301A?

01

Individuals and families seeking assistance programs provided by the New Hampshire Department of Health and Human Services.

02

Applicants for health coverage, food assistance, or financial aid.

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What is NH DHHS 301A?

NH DHHS 301A is a form used by the New Hampshire Department of Health and Human Services for reporting specific health-related data or services.

Who is required to file NH DHHS 301A?

Individuals or organizations that provide certain health services in New Hampshire and are required to report data to the NH DHHS are obligated to file NH DHHS 301A.

How to fill out NH DHHS 301A?

To fill out NH DHHS 301A, you should gather the required information, follow the instructions provided on the form, and ensure that all sections are completed accurately before submitting.

What is the purpose of NH DHHS 301A?

The purpose of NH DHHS 301A is to collect necessary health-related information that helps the state monitor and improve public health services.

What information must be reported on NH DHHS 301A?

The information that must be reported on NH DHHS 301A typically includes details about services provided, demographic information of recipients, and any relevant health outcomes.

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