Application Form By electronically signing or submitting the Application Form you:
CONTRACT FORM Observe the Contract and confirm the form number on the Contract is on the List of Approved Contract Forms.
Transfer Format Transfers may include, but are not limited to, conversion of all Data into or from an industry standard format or providing application programmable interface. ENCRYPTION Data must be encrypted at all times unless specifically outlined otherwise in the Authorized User Agreement. At a minimum, encryption must be carried out at the most current NYS Encryption Standard (NYS-S14-007), (or successor policy with key access restricted to the Authorized User only, unless with the express written permission of the Authorized User. All Data in transit must be handled in accordance with ITS Policy NYS-S14-007 (or successor) or the National Institute of Standards and Technology (NIST) Federal Institute Processing Standard (FIPS)-140-2 or Transport Layer Security (TLS) 1, or TLS2 (or successor). The Authorized User Agreement shall specify the respective responsibilities of the Authorized User and the Contractor for the encryption of Data.
Form instructions 1. This form does not mandate the use of a specific font size or style but the font must be legible.
Vendor Agreement Signature Form (Part 1)
BILLING FORM The SUDRF shall use the Centers for Medicare and Medicaid Services (CMS) 1450 UB-04 billing form (or subsequent editions) for inpatient services, and the CMS 1500 Claim Form for outpatient services. The SUDRF shall identify SUDRF care on the billing form in the remarks block by stating “SUDRF care”.
DRUG-FREE WORKPLACE FORM The Drug-Free Workplace Form is attached and shall be completed and submitted with your bid.
INSTRUCTIONS FOR COMPLETING FORM A AND B Form A and Form B should be completed for Contracts for consulting services in accordance with Section XI.18.C of the Office of the State Comptroller’s Guide to Financial Operations (xxxx://xxx.xxx.xxxxx.xx.xx/agencies/guide/MyWebHelp/), “Consultant Disclosure Legislation,” and the following:
Resume Self-Certification Form When submitting a response to an RFQ the Contractor shall submit with its response a completed and signed Resume Self-Certification Form (Contract Exhibit F) to the Customer for each proposed Staff member identified in the RFQ response.
Order Form (a) You may request Services or Equipment from us at any time by completing and submitting an order to us in our standard form.