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State of Illinois Department of Human ServicesAPPLICATION FOR INITIAL CERTIFICATION OF MEDICAID COMMUNITY MENTAL HEALTH SERVICESPART Identifying Information Certifying State Agency to which application

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How to fill out application for initial certification

01

Download the application form for initial certification from the official website or request a hard copy from the relevant certifying body.

02

Fill out the applicant information section with your personal details including name, contact information, and any relevant qualifications or experience.

03

Provide documentation or evidence of meeting the certification requirements such as transcripts, work experience, or references.

04

Pay the required application fee, if applicable, and submit the completed form along with all supporting documents to the certifying body.

05

Await confirmation of receipt and processing of your application, which may include an interview or assessment process.

Who needs application for initial certification?

01

Individuals who are seeking to obtain certification in a specific field or profession typically need to submit an application for initial certification.

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What is application for initial certification?

It is a form or process required to obtain certification for the first time.

Who is required to file application for initial certification?

Individuals or entities seeking certification for the first time are required to file the application.

How to fill out application for initial certification?

The application can typically be filled out online or by mail, following the instructions provided by the certifying body.

What is the purpose of application for initial certification?

The purpose is to verify that the applicant meets the necessary requirements for certification.

What information must be reported on application for initial certification?

Information such as qualifications, experience, education, and any other requirements specified by the certifying body.

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