Provider Agreement. I declare that I have read and understood the requirements as stated in this document and I agree to comply with these requirements. I further declare that all of the information I have provided on this form is true and correct to the best of knowledge. I agree to notify the county within 10 calendar days if any of the information I have provided in this Provider Workweek and Travel time Agreement changes, and depending on what information has changed, I may be required to complete a new SOC 2255.
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Samples: In Home Supportive Services Provider Workweek & Travel Time Agreement, In Home Supportive Services Provider Workweek & Travel Time Agreement, In Home Supportive Services Provider Workweek & Travel Time Agreement
Provider Agreement. I declare that I have read and understood the requirements as stated in this document and I agree to comply with these requirements. I further declare that all of the information I have provided on this form is true and correct to the best of my knowledge. I agree to notify the county within 10 calendar days if any of the information I have provided in this Provider Workweek and Travel time Agreement changes, and depending on what information has changed, I may be required to complete a new SOC 2255.
Appears in 1 contract
Provider Agreement. I declare that I have read and understood understand the requirements as stated in this document and I agree to comply with these requirements. I further declare that all of the information I have provided on this form is true and correct to the best of knowledgecorrect. I agree to notify the county within 10 calendar days if any of the information I have provided in this Provider Workweek and Travel time Agreement changes, and depending on what information has changed, I may be required to complete a new SOC 2255.
Appears in 1 contract
Samples: In Home Supportive Services (Ihss) Provider Workweek & Travel Time Agreement