Get Nys Form Doh 4425

This guide provides clear instructions on how to correctly complete the Nys Form Doh 4425 online. By following these steps, users will ensure that their submission is accurate and complete, facilitating a smoother audit exemption process.

Follow the steps to successfully fill out the online form.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by filling in the agency name in the designated field. Ensure that the name matches the official name used for your registered organization.
3. Enter all related FEINs in the provided fields. This includes any federal employer identification numbers associated with the agency.
4. Complete the contact information by providing the name of the individual responsible for this submission, along with their title.
5. Affix the signature in the appropriate section, along with the date that the form is being completed.
6. Fill in the contact telephone number and email address accurately to ensure effective communication if needed.
7. Indicate the fiscal year end date in the specified format to clarify the reporting period.
8. Report the total federal funding received during the fiscal year, including any program income, in the total federal funding field.
9. Similarly, provide the total NYSDOH funding, inclusive of program income, in the corresponding field.
10. In the certification section, check the applicable boxes indicating the exemptions that apply to your agency based on federal and state funding thresholds.
11. Complete the auditor's section by filling out the firm name, CPA name, New York State license number, signature, date, and contact information.
12. Attach any necessary financial statements as required by the submission guidelines.
13. Once all sections are accurately filled out, users can save changes, download a copy of the form, print, or share it as needed.

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