Get Doh Form 5039

Filling out the Doh Form 5039 online is an essential process for submitting your account request for the Health Commerce System. This guide will provide you with clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete the Doh Form 5039 successfully.

1. Click ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin with the 'Director' section. Enter the full first name, middle name, and last name of the director. Include the month and day of their birth, followed by their job title.
3. Provide the work address, office phone number/extension, office fax number, and email address of the director. If applicable, include their NYSDOH Health Commerce System ID.
4. Complete the ‘Date Completed’ field to indicate when the form is being filled out.
5. Move on to the 'Coordinator' section. Fill in the full first name, middle name, and last name of each coordinator. Again, include the month and day of their birth.
6. Input the name of the HCS director from above, along with the work address, office phone number/extension, office fax number, and email address for each coordinator. Include their NYSDOH Health Commerce System ID if available.
7. Complete the 'Date Completed' field for each coordinator as well.
8. Finally, mail the completed form to NYSDOH Child & Adult Care Food Program, 150 Broadway FL6W Rm 650, Albany, NY 12204.
9. To conclude, review the full form for accuracy, and then save your changes, download the document, or print it for submission.

Complete your Doh Form 5039 online today to streamline your account request process.