Associate Agreement Form Sample Clauses

Associate Agreement Form. □ 1199 Dues Deduction Authorization (If Applicable) □ Conflict of Interest Survey □ Emergency Contact Form □ Direct Deposit Form (optional)(attach voided check) □ Ethnicity/Race and Sex Self-Identification FormTax Forms o W4 o IT-2104 (NYS/NYC) o IT-2104.1 (Yonkers Non-Residency Certificate) □ Acknowledgement Form
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Related to Associate Agreement Form

  • Business Associate Agreement This Agreement may require the exchange of information covered by the U.S. Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). A Business Associate Agreement (“BAA”) executed by the Parties is attached as Appendix [Letter C/D/E etc.].

  • ATTACHMENT E BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (“Agreement”) is entered into by and between the State of Vermont Agency of Human Services, operating by and through its Department of Vermont Health Access (“Covered Entity”) and OptumInsight, Inc. (“Business Associate”) as of June 6, 2014 (“Effective Date”). This Agreement supplements and is made a part of the contract/grant to which it is attached. Covered Entity and Business Associate enter into this Agreement to comply with standards promulgated under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), including the Standards for the Privacy of Individually Identifiable Health Information, at 45 CFR Parts 160 and 164 (“Privacy Rule”), and the Security Standards, at 45 CFR Parts 160 and 164 (“Security Rule”), as amended by Subtitle D of the Health Information Technology for Economic and Clinical Health Act (HITECH), and any associated federal rules and regulations. The parties agree as follows:

  • Separate Agreement The parties hereto acknowledge that certain provisions of the Investment Company Act, in effect, treat each series of shares of an investment company as a separate investment company. Accordingly, the parties hereto hereby acknowledge and agree that, to the extent deemed appropriate and consistent with the Investment Company Act, this Agreement shall be deemed to constitute a separate agreement between the Investment Manager and each Fund.

  • Vendor Agreement Signature Form (Part 1)

  • Business Associate Addendum The Parties acknowledge and agree that Medical Practice is a Covered Entity and Modernizing Medicine is a Business Associate under HIPAA and each Party shall comply with the Party’s respective obligations under HIPAA. Without limiting the foregoing, each Party shall comply with the Business Associate Addendum attached to these Terms and Conditions as Exhibit A (the “Business Associate Addendum”). The Business Associate Addendum is hereby incorporated into this Agreement.

  • ARTICULATION AGREEMENT FOLLOW-UP PROCEDURES

  • Addendum to Agreement Students who do not complete an AA/AS degree can use the prescribed curriculum in a statewide transfer articulation agreement as a common advising guide for transfer to all public institutions that offer the designated bachelor’s degree program. Please note the following:

  • ADDENDUM Notwithstanding any provisions of this Award Agreement to the contrary, to the extent you transfer employment outside of the United States, the Award shall be subject to any special terms and conditions as Tyson may need to establish to comply with local laws, rules, and regulations or to facilitate the operation and administration of the Award and the Plan in the country to which you transfer employment (or Tyson may establish alternative terms and conditions as may be necessary or advisable to accommodate your transfer). Any such terms and conditions shall be set forth in an Addendum prepared by Tyson which shall constitute part of this Award Agreement.

  • Business Associate Contract A. GENERAL PROVISIONS AND RECITALS

  • Item Agreement As negotiated items are agreed upon, they shall be reduced to writing and initialed by the chief negotiator of each party. Such initialing shall be construed as tentative agreement by both parties on that item or issue, subject to finalization by ratification by the membership of the Association and adoption by the Board.

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