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Department of Health Care Access and Information Office of Statewide Hospital Planning and DevelopmentNONMATERIAL ALTERATION CHANGE FORM (HCAIOSH103) NMA # Facility ID # Client Document(s) Name: Facility

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How to fill out non-material alteration change form

01

Obtain the non-material alteration change form from the appropriate department or website.

02

Fill out the applicant information section, including name, address, and contact information.

03

Provide details of the proposed alteration or change, including the reason for the change and how it will be implemented.

04

Include any supporting documentation or sketches that may be required to illustrate the proposed alteration.

05

Sign and date the form, certifying that the information provided is true and accurate.

06

Submit the completed form to the relevant authority for review and approval.

Who needs non-material alteration change form?

01

Anyone who wishes to make a non-material alteration to a specific process, system, or document may need to fill out a non-material alteration change form.

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What is non-material alteration change form?

Non-material alteration change form is a form used to report minor modifications or changes to a previously filed document or record.

Who is required to file non-material alteration change form?

Any individual or entity who needs to make non-material alterations to a previously filed document or record is required to file the non-material alteration change form.

How to fill out non-material alteration change form?

To fill out the non-material alteration change form, one must provide details of the original document, the changes being made, and any additional information required by the governing authority.

What is the purpose of non-material alteration change form?

The purpose of the non-material alteration change form is to ensure transparency and accuracy in reporting any modifications or changes to previously filed documents or records.

What information must be reported on non-material alteration change form?

The non-material alteration change form must include details of the original document, the specific changes being made, and any additional information required by the governing authority.

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