Common Contracts
2 similar Foster Home Medicaid Provider Enrollment Agreement contracts
Foster Home Medicaid Provider Enrollment AgreementFoster Home Medicaid Provider Enrollment Agreement • May 20th, 2022
For providers with foster homes for developmentally disabled children or child welfare foster homes, complete sections A and B only. For all other providers, complete all sections as applicable.
Office of Licensing and Regulatory Oversight Foster Home Medicaid Provider Enrollment AgreementFoster Home Medicaid Provider Enrollment Agreement • August 4th, 2014
Disclosure of Social Security numbers is required pursuant to 42 USC 405(c)(2)(C)(i) for the purpose of establishing identification, 42 CFR 455.104 for the purpose of exclusion verification, and 26 CFR 301.6109-1 for the purpose of reporting tax information.
