Participant Information My address is: My Social Security Number is:
Relevant Information The Issuer shall cause each Service Provider having Relevant Information in its possession to make such Relevant Information available to the Administrator and the Manager not later than 1:00 p.m., New York City time, at least five Business Days prior to each Payment Date.
APPLICANT INFORMATION We are a child safe and equal opportunity employer. Applications from Aboriginal and Xxxxxx Xxxxxx Islander people, people with a disability and people from culturally and linguistically diverse backgrounds are encouraged. In addition, applications for positions that work with children must provide referees who can comment on their experience working with children. These roles also require a valid
Other Important Information Collection costs You agree to pay our reasonable costs for collecting amounts due, including reasonable attorneys’ fees and court costs incurred by us or another person or entity, to the extent not prohibited by applicable law and except as provided below.
Other Relevant Information This information shall always be in writing and shall address other relevant information as required by the contract or requested by the RFP. For example, in accordance with Section H, H106, Avoidance of Organizational Conflicts of Interest, identifying any situation in which the potential for a conflict of interest exists. If travel is specified in the TO PWS or statement of work, air fare and/or local mileage, per diem rates by total days, number of trips and number of contractor employees traveling shall be included in the cost proposal (see clause H047).
Disclosure of Account Information to Third Parties It is our general policy to treat your account information as confidential. However, we will disclose information to third parties about your account or the transactions you make in the following situations pursuant to our Privacy Policy (as further described in Section 10 (Your Privacy) of the General Terms), in addition to the circumstances set forth in Section 20 of the General Terms (Information Authorization):
ADDITIONAL GRANT INFORMATION Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency Contract No. HHS000663700196 Health and Human Services Commission Nexus Recovery Center Xxxxx Xxxxxx Name: Xxxxxxx Xxxxxx Assoc. Commissioner IDD/BH Date of execution: _July 21, 2020 Title: Executive Director/CEO Date of execution: July 21, 2020 The following attachments to System Agency Contract No. HHS000663700196 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.
Processing of Personal Information We treat your personal information confidentially and in accordance with applicable legislation. When you purchase insurance from us, we gather information in connection with enrolment, filing a claim and use of our digital platforms, e.g. civil registration number, telephone number, e-mail address, membership of Sygeforsikringen ”danmark”, industry, employment, marital status and any health information. This information is used to create and administer the insurance policy for use in case of a claim and in the ongoing case processing to ensure the best possible service and as part of sales management, product development, quality assurance, advice and determination of general user behaviour. We retain the gathered information for as long as necessary and in accordance with the applicable legislation. You can always contact us if you want to know which personal information, we have registered about you. You are entitled to change incorrect information. On our website, xx-xxxxxxx.xx, you can read more about data security and how we handle your personal information. In some cases, we pass personal information about you to the suppliers with whom we cooperate.
