Out of State Applicants Sample Clauses

Out of State Applicants. Individuals who reside outside the State of Illinois and do not have an opportunity to submit their fingerprints to one of the electronic fingerprint facilities specified above must submit fingerprint cards for the Illinois State Police and the FBI. The Department suggests that those NET provider applicants who must be fingerprinted contact a local police authority in their state of residence to obtain classifiable prints. Fingerprint cards generally available at local police stations will not be accepted, nor will copies of cards! Please send your request for the approved fingerprint cards to: Illinois Department of Public Aid Office of Inspector General /CVU 000 Xxxxx 0xx Xxxxxx Springfield, Illinois 62702 000-000-0000 State of Illinois Department of Healthcare and Family Services ENROLLMENT DISCLOSURE STATEMENT ILLINOIS MEDICAL ASSISTANCE PROGRAM
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Out of State Applicants. Individuals who reside outside the State of Illinois and do not have an opportunity to submit their fingerprints to one of the electronic fingerprint facilities specified above must submit fingerprint cards for the Illinois State Police and the FBI. The Department suggests that those NET provider applicants who must be fingerprinted contact a local police authority in their state of residence to obtain classifiable prints. Fingerprint cards generally available at local police stations will not be accepted, nor will copies of cards! Please send your request for the approved fingerprint cards to: Illinois Department of Public Aid Office of Inspector General /CVU 000 Xxxxx 0xx Xxxxxx Springfield, Illinois 62702 000-000-0000 DPA 2243 (R-12-2000) IL 478-1934 DO NOT RETURN THIS PAGE DO NOT RETURN THIS PAGE INSTRUCTIONS ILLINOIS MEDICAL ASSISTANCE PROGRAM PROVIDER ENROLLMENT APPLICATION Enrollment in the Illinois Medical Assistance Program requires the completion of an application with an original signature of an individual or if a business entity, an authorized person. All providers are required to complete, sign and date a Provider Agreement. Enclose additional pages when more information is available than space allows or here which ever is appropriate. Providers are required by the U.S. Postal Service to use a 9 digit zip code for all addresses. Mail without the 9 digits may be returned by the U.S. Postal Service. Providers required to submit the Disclosure of Ownership and Control Interest Statement Form (HCFA 1513) for participation in the Federal Medicare Program, are required to submit a copy of the HCFA 1513 to the Illinois Department of Public Aid.
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Out of State Applicants. Individuals who reside outside the State of Illinois and do not have an opportunity to submit their fingerprints to one of the electronic fingerprint facilities specified above must submit fingerprint cards for the Illinois State Police and the FBI. The Department suggests that those NET provider applicants who must be fingerprinted contact a local police authority in their state of residence to obtain classifiable prints. Fingerprint cards generally available at local police stations will not be accepted, nor will copies of cards! Please send your request for the approved fingerprint cards to: Illinois Department of Public Aid Office of Inspector General /CVU 000 Xxxxx 0xx Xxxxxx Springfield, Illinois 62702 000-000-0000 Form W-9(Rev. October 2007)Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give form to the requester. Do no send to the IRS. Print or type See Specific Instructions on page 2. Name (as shown on your income tax return) Business name, if different from above Check appropriate box: Individual/Sole proprietor Corporation Partnership Limited liability company. Enter the tax classification (D=disregarded entity, C=corporation, P=partnership) } Other (see instructions) } Exempt payee Address (number, street, and apt. or suite no.) Requester’s name and address (optional) City, state, and ZIP code List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
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Out of State Applicants. SCDOT shall review and make an eligibility determination on all firms applying for DBE/SBE certification whose business is located in the State of South Carolina. SCDOT will accept applications from firms located across state lines in accordance with USDOT’s Interstate Certification Process.
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Related to Out of State Applicants

  • Out-of-State Travel Costs for travel outside Texas or the United States are unallowable unless a Request to Use TJJD Funds to Attend Out-of-State Training [TJJD-CER-01-11] has been submitted by the Grantee and prior written approval of the trip and projected costs for such travel has been granted by the Department.

  • Department of State Registration Consistent with Title XXXVI, F.S., the Contractor and any subcontractors that assert status, other than a sole proprietor, must provide the Department with conclusive evidence of a certificate of status, not subject to qualification, if a Florida business entity, or of a certificate of authorization if a foreign business entity.

  • Security of State Information To the extent Contractor shall have access to, processes, handles, collects, transmits, stores or otherwise deals with State Data, the Contractor represents and warrants that it has implemented and it shall maintain during the term of this Master Agreement the highest industry standard administrative, technical, and physical safeguards and controls consistent with NIST Special Publication 800-53 (version 4 or higher) and Federal Information Processing Standards Publication 200 and designed to (i) ensure the security and confidentiality of State Data; (ii) protect against any anticipated security threats or hazards to the security or integrity of the State Data; and (iii) protect against unauthorized access to or use of State Data. Such measures shall include at a minimum: (1) access controls on information systems, including controls to authenticate and permit access to State Data only to authorized individuals and controls to prevent the Contractor employees from providing State Data to unauthorized individuals who may seek to obtain this information (whether through fraudulent means or otherwise); (2) industry-standard firewall protection; (3) encryption of electronic State Data while in transit from the Contractor networks to external networks; (4) measures to store in a secure fashion all State Data which shall include multiple levels of authentication; (5) dual control procedures, segregation of duties, and pre-employment criminal background checks for employees with responsibilities for or access to State Data; (6) measures to ensure that the State Data shall not be altered or corrupted without the prior written consent of the State; (7) measures to protect against destruction, loss or damage of State Data due to potential environmental hazards, such as fire and water damage; (8) staff training to implement the information security measures; and (9) monitoring of the security of any portions of the Contractor systems that are used in the provision of the services against intrusion on a twenty-four (24) hour a day basis.

  • Secretary of State The Secretary of State of the State of Delaware.

  • Summary of State Ethics Laws Pursuant to the requirements of section 1-101qq of the Connecticut General Statutes, the summary of State ethics laws developed by the State Ethics Commission pursuant to section 1-81b of the Connecticut General Statutes is incorporated by reference into and made a part of the Contract as if the summary had been fully set forth in the Contract.

  • Limitation on Out-of-State Litigation - Texas Business and Commerce Code § 272 This is a requirement of the TIPS Contract and is non-negotiable. Texas Business and Commerce Code § 272 prohibits a construction contract, or an agreement collateral to or affecting the construction contract, from containing a provision making the contract or agreement, or any conflict arising under the contract or agreement, subject to another state’s law, litigation in the courts of another state, or arbitration in another state. If included in Texas construction contracts, such provisions are voidable by a party obligated by the contract or agreement to perform the work. By submission of this proposal, Vendor acknowledges this law and if Vendor enters into a construction contract with a Texas TIPS Member under this procurement, Vendor certifies compliance.

  • Mobile Application If Red Hat offers products and services through applications available on your wireless or other mobile Device (such as a mobile phone) (the "Mobile Application Services"), these Mobile Application Services are governed by the applicable additional terms governing such Mobile Application Service. Red Hat does not charge for these Mobile Application Services unless otherwise provided in the applicable additional terms. However, your wireless carrier's standard messaging rates and other messaging, data and other rates and charges will apply to certain Mobile Application Services. You should check with your carrier to find out what plans your carrier offers and how much the plans cost. In addition, the use or availability of certain Mobile Application Services may be prohibited or restricted by your wireless carrier, and not all Mobile Application Services may work with all wireless carriers or Devices. Therefore, you should check with your wireless carrier to find out if the Mobile Application Services are available for your wireless Device, and what restrictions, if any, may be applicable to your use of such Mobile Application Services.

  • Insurance Application An employee on unpaid leave is eligible to continue to participate in group insurance programs if permitted under the insurance policy provisions. The employee shall pay the entire premium for such insurance commencing with the beginning of the leave and shall pay to the School District the monthly premium in advance, except as otherwise provided in law. In the event the employee is on paid leave from the School District under Section 1. above or supplemented by sick leave pursuant to Section 2. above, the School District will continue insurance contributions as provided in this Agreement until sick leave is exhausted. Thereafter, the employee must pay the entire premium for any insurance retained.

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