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MARKET SQUARE PLAZA 17 N SECOND STREET, 13TH FL HARRISBURG, PA 17101 pH 717.787.3717 FX 717.787.8773 W www.banking.state.pa.us ALTERNATE SITE RECORDKEEPING APPROVAL REQUEST FORM UNDER THE CONSUMER
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How to fill out cdca alternate site request

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To fill out the CDCA alternate site request, follow the steps below:

01
Visit the official CDC website and navigate to the alternate site request section.
02
Download the CDCA alternate site request form.
03
Fill in the required information, such as your name, contact details, and organization.
04
Provide specific details about the alternate site you are requesting, including the location, facilities, and support services available.
05
Clearly state the reason for the alternate site request and why it is necessary for your organization.
06
Attach any supporting documents or evidence that can strengthen your request.
07
Double-check all the information provided and ensure its accuracy.
08
Sign and date the form.
09
Submit the filled-out CDCA alternate site request form through the designated submission method provided on the CDC website.

Who needs the CDCA alternate site request?

The CDCA alternate site request is needed by organizations or individuals who require an alternate site for conducting specific activities. This could include public health agencies, research institutions, or organizations involved in emergency response planning. The request is particularly relevant when there are limitations or challenges at the primary site that hinder the execution of essential functions. By submitting the CDCA alternate site request, these organizations can request approval and support from the CDC to establish an alternate site and continue their operations effectively.
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A CDCA alternate site request is a request to receive COVID-19 vaccine supply directly from the CDC's central distributor and not through the state or local health departments.
Healthcare providers or organizations that meet certain criteria and have the ability to administer a large number of COVID-19 vaccines are required to file a CDCA alternate site request.
The CDCA alternate site request can be filled out online on the CDC's website by providing the necessary information about the healthcare provider or organization.
The purpose of the CDCA alternate site request is to streamline the distribution of COVID-19 vaccines to larger healthcare providers or organizations that have the capacity to administer vaccines more efficiently.
The CDCA alternate site request requires information such as healthcare provider details, storage and handling capabilities, vaccination capacity, and vaccine ordering preferences.
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Pennsylvania RECORDKEEPING Licensee HARRISBURG CDCA 13TH rknaubpa Fx Knaub licensees Attn Licensing acknowledges incorrectly retains gov unsigned submitting Pursuant notifying Dept FL notification terminating collectively Compliance TERMINATION receives

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