Get W: Ocij Devintranet Crosbyc Portland Declaration Of Fee Pymt .wpd. Medicaid Timely Payment Report

Filling out the W: OCIJ DEVIntranet CrosbyC Portland Declaration Of Fee Pymt .wpd. Medicaid Timely Payment Report is essential for documenting fee payments. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully fill out the form.

1. Click 'Get Form' button to acquire the form and open it in your editing tool.
2. Begin by entering your name in the designated space provided at the top of the form, where it states 'I, _________________________________________________________ do hereby [your name]'.
3. In the next section, indicate the fee amount you have paid by filling in the blank next to '$ _______.____'. Ensure that the amount is accurate.
4. Specify the purpose of the payment by checking the appropriate box for either 'motion' or 'application', and provide the required details next to each option.
5. Enter the date of payment in the designated area marked 'on______________________________'.
6. Indicate whether a copy of the payment method (check or money order) is attached by circling either 'is' or 'is not' in the relevant area.
7. Sign the form in the space provided at the bottom where it says 'SIGNATURE'. Ensure your signature is clear and legible.
8. Proceed to the 'CERTIFICATE OF SERVICE' section. Enter your name, and indicate how you delivered the document (by mailing or hand delivering) by circling the appropriate option.
9. Fill in the date of delivery in the space provided and provide your signature at the bottom of this section as well.
10. Finally, review all entries for accuracy, then save changes, download the form, or share it according to your needs.

Start filling out your documents online today for a seamless process.