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Get Download Request For Reimbursement And Report Of ... - Dsf Health State Pa
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How to fill out the Download REQUEST FOR REIMBURSEMENT AND REPORT OF SCHOOL HEALTH SERVICES online
Navigating the Download REQUEST FOR REIMBURSEMENT AND REPORT OF SCHOOL HEALTH SERVICES can seem daunting, but with this guide, you will find step-by-step assistance to complete the form effectively. This document is essential for educational institutions seeking reimbursement for school health services provided during the academic year.
Follow the steps to successfully complete the form.
- Press the ‘Get Form’ button to obtain the form and open it in your editing tool.
- Fill in the school year at the top of the form, ensuring it reflects the current academic year.
- Provide your health district and county details in the specified fields.
- Enter the current vendor number associated with the dental program, as required.
- In the educational institution name and address section, accurately input the full name and address of your institution.
- Select the mandated program that applies by checking the relevant box, such as hygiene or dental services program.
- Indicate the type of institution you are representing by selecting either school district, charter school, or comprehensive vocational-technical, along with the institution's phone number.
- Provide contact information for the primary contact person, including their first name, last name, title, phone number, and email address.
- Detail the itemized expenditures by filling in the total costs for each specified service, ensuring to carry forward totals as instructed in the subsequent sections.
- Complete sections for average daily membership and cost of services, breaking down costs by medical and dental services as required.
- In the certification statement at the end of the document, ensure that it is signed by the district superintendent or chief executive officer, and include their printed name.
- Review all entered information for accuracy before saving changes, downloading, printing, or sharing the completed form.
Begin your reimbursement process by completing the form online today.
The application for design registration must be filed with Form-1 along with the following details: Name of applicant. Address of the applicant. Nationality of the applicant. In the case of a company, information regarding the place of incorporation and the legal status of the entity. The required fee is applicable.
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