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Determiner Name: ___MEDICAID PRESUMPTIVE ELIGIBILITY AUTHORIZATIONDeterminer Fax Number: ___Fax this form to:5058277200PE Determiner: List ONLY the individuals who are Eligible for PE. Type all information directly into this form. The PE eligibility End Date is the last day of the month following the PE approval. If an application for ongoing Medicaid eligibility is submitted on or before the PE Eligibility End Date, the PE will remain in effect until a final application determination has...
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What is determiner name?
A determiner name is a specific term used to identify individuals or entities that are responsible for filing official documents, often related to legal or tax matters.
Who is required to file determiner name?
Individuals or entities engaging in legal or financial activities that require official reporting, such as businesses, organizations, or sole proprietors, are typically required to file a determiner name.
How to fill out determiner name?
To fill out a determiner name, provide the required information accurately, including the name of the individual or entity, any associated identification numbers, and relevant contact details, following the specific form's instructions.
What is the purpose of determiner name?
The purpose of a determiner name is to establish accountability and traceability for legal and financial activities recorded in official documents, ensuring compliance with regulations.
What information must be reported on determiner name?
The information that must be reported includes the full name of the determiner, business address, identification numbers (like EIN), and other relevant details as specified by the filing requirements.
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