TITLE II RESPONSE RECORD LAYOUT - ABRIDGED Sample Clauses

TITLE II RESPONSE RECORD LAYOUT - ABRIDGED. (this is appended to SSN Verification/Standard Response) DATA ELEMENT POSITION Title II Claim Account Number (CAN) and BIC 157-168 State and County Code 169-173 ZIP Code 174-178 ZIP + 4 179-182 Number of Lines of Address 183 Address 184-315 Direct Deposit Indicator 316 DATA ELEMENT POSITION Deferred Payment Date 317-322 Schedule Payment Indicator 323 Schedule Payment Date 324-329 Schedule Prior Payment Amount 330-336 Schedule Current Payment Amount 337-342 Schedule Payment Combined Check Indicator 343 LAF (Ledger Account File) Code 344-345 Date of Birth 346-353 Proof of Age Indicator 354 Given Name 355-364 Middle Initial 365 Surname 366-377 DATA ELEMENT POSITION Date of Initial Entitlement 378-383 Date of Current Entitlement 384-389 Date of Suspension or Termination 390-395 Sex Code 396 Net Monthly Benefit if Payable (MBP) 397-402 Medicare Indicator 403 Hospital Insurance (HI) Indicator 404 HI Option Code 405 HI Start Date 406-411 HI Stop Date 412-417 HI Premium 418-422 HI Buy-In Indicator 423 DATA ELEMENT POSITION HI Buy-In Code 424-426 HI Buy-In Start Date 427-432 HI Buy-In Stop Date 433-438 Supplemental Medical Insurance (SMI) Indicator 439 SMI Option Code 440 SMI Start Date 441-446 SMI Stop Date 447-452 SMI Premium 453-457 SMI Buy-In Indicator 458 SMI Buy-In Code 459-461 SMI Buy-In Start Date 462-467 SMI Buy-In Stop Date 468-473 Welfare Agency Code 474-476 DATA ELEMENT POSITION Category of Assistance Code 477 Black Lung Entitlement Code 478 Black Lung Payment Amount 479-484 Railroad Indicator 485 Person's Own Social Security Number (SSN) 486-494 Date of Death 495-502 Disability Onset Date 503-510 Number of Cross-reference Account Number (XRAN) Occurrences 511 Cross-Reference (XREF) Entitlement Number * 512-571 (Field 1) Cross-Reference (XREF) BIC * 512-571 (Field 2) Cross-Reference (XREF) Code * 512-571 DATA ELEMENT POSITION (Field 3) Dual Entitlement Number 572-580 Dual Entitlement BIC 581-582 Number of History Occurrences 583-584 Monthly Benefit Credited (MBC) Date ** 585-688 (Field 1) MBC Amount ** 585-688 (Field 2) MBC Type ** 585-688 (Field 3) Other Date of Entitlement 689-694 Other Primary Insurance Amount 695-700 Other Retirement Insurance Amount 701-706 Larger Full Monthly Benefit Amount 707-712 DATA ELEMENT POSITION Larger Excess Monthly Benefit Amount 713-718 Smaller Full Monthly Benefit Amount 719-724 Smaller Actuarially Reduced Monthly Benefit Amount 725-730 Dual Entitlement Status Code 731 Other Office Code 732 Type of Dual Entitlement 733...
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Related to TITLE II RESPONSE RECORD LAYOUT - ABRIDGED

  • Optional Xactimate Response Attachment (Part 2)

  • Training Delivery Type Code -- Code Short Description Long Description (If Applicable) 01 Traditional Classroom (no technology)

  • Contractor Certification Regarding Ethics The Contractor certifies that the Contractor is now, and shall remain, in compliance with Chapter 42.52 RCW, Ethics in Public Service, throughout the term of this Contract.

  • Drug-Free Workplace Certification As required by Executive Order No. 90-5 dated April 12, 1990, issued by the Governor of Indiana, the Contractor hereby covenants and agrees to make a good faith effort to provide and maintain a drug-free workplace. The Contractor will give written notice to the State within ten (10) days after receiving actual notice that the Contractor, or an employee of the Contractor in the State of Indiana, has been convicted of a criminal drug violation occurring in the workplace. False certification or violation of this certification may result in sanctions including, but not limited to, suspension of contract payments, termination of this Contract and/or debarment of contracting opportunities with the State for up to three (3) years. In addition to the provisions of the above paragraph, if the total amount set forth in this Contract is in excess of $25,000.00, the Contractor certifies and agrees that it will provide a drug-free workplace by:

  • Contents of Personnel File A. Adverse statements prepared by the County shall not be included in an employee's official personnel file unless a copy is provided to the employee.

  • Line Item Question Response 43 Do your warranties cover all products, parts, and labor? Axon warrants that its law enforcement hardware products which are manufactured by Axon are free from defects in workmanship and materials for a period of one (1) year from the date of receipt. Axon-manufactured accessories are covered under a limited ninety-day warranty from the date of receipt. Non-Axon manufactured accessories are covered under the manufacturer's warranty. There are extended warranties available as defined in the Axon Master Services and Purchasing Agreement (MSPA). NON-AXON MANUFACTURED PRODUCTS For some solutions we are authorized resellers of hardware (Cradlepoint routers for Axon Fleet, Axis cameras for Axon Interview, etc.). Products that we are authorized to resell abide by the manufacturer's warranty. Further details can be provided upon request. * 44 Do your warranties impose usage restrictions or other limitations that adversely affect coverage? Restrictions are outlined in our warranty, which has been included in the uploaded attachments. * 45 Do your warranties cover the expense of technicians' travel time and mileage to perform warranty repairs? Our warranties do not cover the expense of technicians' travel time and mileage to perform warranty repairs. * 46 Are there any geographic regions of the United States (and Canada, if applicable) for which you cannot provide a certified technician to perform warranty repairs? How will Sourcewell Members in these regions be provided service for warranty repair? Axon will be available 24 hours/7 days per week by phone for emergency technical support for any system outage, and if mutually agreed upon by both parties, we can provide onsite support for local issues. If a site visit is deemed necessary due to an issue (i.e. access point failures or accidental cut wires) and not an Axon or Axon Evidence issue there may be a charge assessed to the agency. * 47 Will you cover warranty service for items made by other manufacturers that are part of your proposal, or are these warranties issues typically passed on to the original equipment manufacturer? Axon will troubleshoot these devices to the best of our ability. If we are unable to resolve the issue and the devices require warranty service, this will be performed by the manufacturer. * 48 What are your proposed exchange and return programs and policies? Axon does not allow exchanges or returns. Please see our MSPA for full details. * 49 Describe any service contract options for the items included in your proposal. Please refer to the included MSPA. * Table 10: Payment Terms and Financing Options Line Item Question Response * 50 What are your payment terms (e.g., net 10, net 30)? Payment terms are Net 30. * 51 Do you provide leasing or financing options, especially those options that schools and governmental entities may need to use in order to make certain acquisitions? Axon does not offer leasing or financing options. Alternatively, Axon offers a provision in its MSPA which allows for cancellation by the agency if sufficient funds are not appropriated. * 52 Briefly describe your proposed order process. Include enough detail to support your ability to report quarterly sales to Sourcewell as described in the Contract template. For example, indicate whether your dealer network is included in your response and whether each dealer (or some other entity) will process the Sourcewell Members' purchase orders. Axon will process orders Axon will accept from Sourcewell members directly, as our distributor network in the United States and Canada does not sell our video products. Our Order Entry team enters orders into our CRM, Salesforce. Reports will be maintained and extracted from Salesforce for quarterly reporting to Sourcewell. *

  • CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS The undersigned (authorized official signing for the contracting organization) certifies that the contractor will, or will continue to, provide a drug-free workplace in accordance with 45 CFR Part 76 by:

  • Certification Regarding Debarment Party certifies under pains and penalties of perjury that, as of the date that this Agreement is signed, neither Party nor Party’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in Federal programs, or programs supported in whole or in part by Federal funds. Party further certifies under pains and penalties of perjury that, as of the date that this Agreement is signed, Party is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment

  • SITE VISITS AND RECORD REVIEW The Applicant shall allow authorized employees of the District, the Comptroller, the Appraisal District, and the State Auditor’s Office to have reasonable access to the Applicant’s Qualified Property and business records from the Application Review Start Date through the Final Termination Date, in order to inspect the project to determine compliance with the terms hereof or as necessary to properly appraise the Taxable Value of the Applicant’s Qualified Property.

  • Review of Personnel File Upon written authority from an employee, OC shall permit the President of the Union or their designate to review that employee's personnel file in the office in which the file is normally kept in order to facilitate the proper investigation of a grievance.

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