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HOSPITAL/HEALTH SYSTEM ATTESTATION OF COMPLIANCE WITH FACILITY FEE PATIENT NOTIFICATION AND TRANSPARENCY REQUIREMENTS OF C.G.S. 19a508c AFFIDAVIT CALENDAR YEAR 2021 Indicate, with a checkmark, that
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How to fill out cy 2021 facilityfeenotice affidavit

01
Review the cy 2021 facilityfeenotice affidavit form carefully to understand all the sections that need to be filled out.
02
Gather all the necessary information and supporting documents required to complete the affidavit.
03
Fill out the personal information section including name, address, and contact details.
04
Provide details about the facility being represented in the affidavit such as name, address, and type of facility.
05
Include information about the fee structure and any changes for the cy 2021 year.
06
Sign and date the affidavit to attest to the accuracy of the information provided.
07
Submit the filled out cy 2021 facilityfeenotice affidavit form as per the instructions provided.

Who needs cy 2021 facilityfeenotice affidavit?

01
Any individual or entity responsible for providing or managing facility fees for a particular facility for the cy 2021 year needs to fill out the cy 2021 facilityfeenotice affidavit.
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The cy facilityfeenotice affidavit is a legal document that must be filed by certain entities to notify the government of any facility fees that are being charged.
Entities that charge facility fees are required to file the cy facilityfeenotice affidavit.
The cy facilityfeenotice affidavit can usually be filled out online or submitted through a specific government portal. It typically requires information about the entity charging fees and the facilities involved.
The purpose of the cy facilityfeenotice affidavit is to provide transparency to the government and the public about facility fees being charged.
The cy facilityfeenotice affidavit commonly requires information such as the name of the entity charging fees, the facilities involved, and the amount of the fees.
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2021 2022 19a 508c attestation rightmost 19a508c 486i ohsnotificationandfilings 110b attests checkmark subdivisions subsections transparency compliant prominently acknowledges applicable subscribed subsection gov pursuant attest uploading notification pre

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