Get the free Discontinuation Application for Exemption - hfsrb illinois

This document serves as an application submitted to the Illinois Health Facilities and Services Review Board for seeking exemption related to the discontinuation of a specific category of service (inpatient obstetrical services) at Lincoln Memorial Hospital, effective December 31, 2022, due to low utilization and changing healthcare needs. The application details the identification, ownership structure, and rationale for the discontinuation, along with safety net provisions and charity care...

How to fill out discontinuation application for exemption

How to fill out discontinuation application for exemption

1. Obtain the discontinuation application form from the relevant authority or website.
2. Carefully read the instructions provided with the application form.
3. Fill in your personal details, including name, address, and contact information.
4. Provide the specific details regarding the exemption you are applying for.
5. Attach any required documentation or evidence to support your application.
6. Review the application for completeness and accuracy.
7. Sign and date the application.
8. Submit the application by the specified method (e.g., mail or online), ensuring it is sent before the deadline.

Who needs discontinuation application for exemption?

1. Individuals or organizations seeking to discontinue a service or benefit that requires an exemption from specific rules or regulations.
2. Those who have a valid reason to request discontinuation of a previously granted exemption.

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What is discontinuation application for exemption?

A discontinuation application for exemption is a formal request submitted to authorities to terminate or discontinue a previously granted exemption from certain obligations, such as taxes or regulations.

Who is required to file discontinuation application for exemption?

Typically, any individual or organization that wishes to end their exemption status is required to file a discontinuation application for exemption.

How to fill out discontinuation application for exemption?

To fill out a discontinuation application for exemption, one must provide the relevant details such as the exemption number, the reason for discontinuation, and any required documentation. The application usually has a standard format that needs to be followed.

What is the purpose of discontinuation application for exemption?

The purpose of the discontinuation application for exemption is to formally notify authorities of the desire to revoke an exemption status and ensure compliance with regulatory requirements moving forward.

What information must be reported on discontinuation application for exemption?

The application must report information such as the name of the individual or entity, exemption identification number, reason for discontinuation, effective date, and any supporting documentation.