Xxxx Xxx xx.xxx/eligibility ➢ From the Login Center Transaction Services screen, enter Userid: your provider number preceded by 5 zeros ➢ Enter state assigned password - call Medi-Cal Provider Relations Phone Support @ 0-000-000-0000 ➢ Click on Submit or press enter ➢ From the Transaction Services screen, double click on Determine Share of Cost ➢ From Perform SOC screen fill in the following fields: ▪ Recipient ID – enter the client’s Social Security # (without dashes) ▪ Date of Birth – enter the client’s DOB (mm/dd/yyyy) ▪ Date of Card Issue – if unknown, and clearing service for the current month, enter today’s date. If you are clearing a retroactive service, you must have the BIC issue date. (mm/dd/yyyy) ▪ Date of Service – enter service date for the “SOC Clearance.” (mm/dd/yyyy) ▪ Procedure Code – enter the procedure code for which the SOC is being cleared. The procedure code is required. (90862, 90841, 90882, etc.) ▪ Billed Amount – enter the amount in dollars and cents of the total xxxx for the procedure code. (ex. 100 dollars would be entered as 100.00). If you do not specify a decimal point, a decimal followed by two zeros will be added to the end of the amount entered. ▪ Share of Cost Case Number – optional unless applying towards family member’s SOC case ▪ Amount of Share of Cost – optional unless a SOC case number was entered ▪ Click on Submit or press enter Note: Click on Back - to return to Transaction Services screen Clear – press this button to clear the fields in the form Patient Recall – once any transaction has been performed on a client, pressing this button will fill in the common fields with all of the information from the last transaction. This is useful for using the same client on different transaction (such as an eligibility verification, then a Share of Cost) or for correcting data when a transaction has gone through with incorrect data. Select SOC Case – this item affects how the Patient Recall button (described above) functions. Simply select the circle above the SOC case number that you want the Patient Recall button to use when it fills out the form. Note that the SOC case numbers are only available if the previous transaction was an Eligibility transaction. The “Last Used” choice contains the SOC Case number that was used if the previous transaction was a SOC transaction. This is also a default choice if none are selected. ATTACHMENT I Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973, as Amended The undersign...
Xxxx Xxx. The disclosed fees and penalties will be included in that projection method applicable to your Financial Disclosure. With the exception of distribution transaction or termination fees, Projection Method One cannot be used if any other Xxxx XXX Fee or certain Other l Rollover/Transfer (one-time) Contribution. boxes are checked below, including the Other box under Early Your age on January 1 of this initial contribution year: Withdrawal Penalty. Earnings Rate: % Fees: Compounding Method: l None . l Xxxx XXX Establishment Fee $ Early Withdrawal Penalty Calculation Method: l Annual Service/Administration Fee of $ $15 . or % of assets will be charged at of each year for purposes of this projection. end l beginning End of Projected Age Projected Year Value Value l Transfer Fee $ l Distribution Fee $ l Removal of Excess $ l Conversions/Recharacterizations $ 1 $ 60 $ 2 $ 65 $ 3 $ 70 $ 4 $ 5 $
Xxxx Xxx. If you have “compensation” and your tax filing status and “adjusted gross income” satisfy certain requirements, you may make annual non-deductible contribution(s) of up to the maximum amount allowed under current law to a Xxxx XXX. You may also be able to convert an existing non-Xxxx XXX to your Xxxx XXX, depending on your adjusted gross income. The income earned on the amounts contributed to a Xxxx XXX will not be subject to tax upon distribution, provided certain requirements are met. If you are married and filing a joint tax return with your spouse, your spouse may also make a contribution to a separate Xxxx XXX established for his or her exclusive benefit, even if your spouse had no compensation for that year.
Xxxx Xxx. Annuitant:..............................................................Xxxx Xxx Age at Issue:........................................................35 Sex:...............................................................Male
Xxxx Xxx. Xx. 000000 Execution Copy
Xxxx Xxx atau Pemegang Kad adalah bersama xxx berasingan xxx/atau bertanggungjawab sepenuhnya/atau bertanggungjawab secara individu untuk semua caj pada Kad Kredit.
Xxxx Xxx. (The minimum investment in Class A, C, and R shares is $2,500. Class I minimum is $100,000. Make checks payable to the Xxxxxx Funds).
Xxxx Xxx. ANNUITANT:..............................................................Xxxx Xxx AGE AT ISSUE:.........................................................35 SEX:................................................................
Xxxx Xxx. 4. As soon as reasonably possible, but no later than 18 months from the entry of this Settlement Agreement, Atlantic shall finish the retrofits listed in Appendix A at 33 West End, including those units owned by Senior Living Options, if any. Atlantic shall make reasonable efforts to minimize inconvenience to residents in making such retrofits.
Xxxx Xxx. ANNUITANT: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
