Get Standardized Board Resolution Form - State Of New Jersey - Newjersey

Filling out the Standardized Board Resolution Form is an essential requirement for contracted Provider Agencies in New Jersey. This guide will help you navigate the process online, ensuring all necessary components are effectively completed.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the contract number in the designated section at the top of the form. This will help identify the specific contract related to your agency.
3. Fill in the contract period by specifying the start and end dates in the appropriate fields.
4. Complete the section for 'Agency' by writing the full name of your organization.
5. The Chairperson of the Board of Directors should certify the accuracy of the information by signing and dating the form in the provided fields.
6. The Executive Director needs to provide their signature and date in the corresponding section.
7. List all authorized signatories for contract documents, checks, and invoices, including their full name and title.
8. In the section regarding Health Insurance Portability and Accountability Act (HIPAA), select the appropriate option (A, B, or C) based on your agency's status.
9. Acknowledge the legal advice section by confirming your understanding that the Department will not provide legal advice.
10. Confirm compliance with Public Law 2005, Chapters 51 and 92 by stating that the forms submitted with the contract are accurate.
11. Once all parts of the form are completed, make sure to save your changes. You can then download, print, or share the document as needed.

Complete your documents online today for a smooth submission process.