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PARR LEVEL II INDEPENDENT BEHAVIORAL HEALTH COMPREHENSIVE EVALUATIONDEMOGRAPHIC INFORMATION Assessment Date Medicaid Number:Recipient Name: (first, middle, last) Age:DOB:Ethnicity:MCO: Gender:Gender
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Gather all necessary information such as personal details, employment information, and financial details.
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Go to the official website of the Department of _______ where the form can be found.
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Individuals who are required to provide personal, employment, and financial information to the Department of _______ may need to fill out form 5113c.
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What is 5113c - department of?
5113c - Department of the Treasury
Who is required to file 5113c - department of?
Individuals or entities with reportable transactions
How to fill out 5113c - department of?
Fill out the form with accurate information about reportable transactions
What is the purpose of 5113c - department of?
To report certain transactions to the Department of the Treasury
What information must be reported on 5113c - department of?
Details of reportable transactions such as amounts, dates, and nature
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