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  • Doh Chrc Bform 106b

Get Doh Chrc Bform 106b

DOH CHRC 106 (05/14) NYS Department of Health CHRC Program Phone: 5184025549 Fax: 5184747477 chrc health.state.ny.us REVOCATION OF AUTHORIZED PERSON DESIGNATION FORM CRIMINAL HISTORY RECORD CHECK.

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How to fill out the DOH CHRC BForm 106b online

Filling out the DOH CHRC BForm 106b online can seem daunting, but this guide will offer clear and supportive instructions to ensure a smooth completion. The DOH CHRC BForm 106b is essential for revoking an Authorized Person's designation within an agency's criminal history record check.

Follow the steps to complete the form successfully.

  1. Press the ‘Get Form’ button to access the form and open it for editing.
  2. In Section 1, provide the Agency Name, PFI/Operating License Number, and the Name of the Authorized Person who is being revoked. If known, include their HCS Account ID.
  3. Move to Section 2 to have the Agency Representative approve the revocation. They must print their Name, Title, and provide a Signature along with the Date.
  4. Once all fields are completed, review the information for accuracy ensuring that all required sections are filled out clearly.
  5. After validation, save the changes made to the form. You will have the option to download, print, or share the completed form for submission.

Begin completing your documents online today for a streamlined process.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232