Get Nd Dhs Sfn 602 2016-2026

Filling out the ND DHS SFN 602 is a straightforward process that helps to request a ROAP ID. This guide provides step-by-step instructions tailored to assist users in completing the form accurately and efficiently online.

Follow the steps to successfully complete the ND DHS SFN 602 form.

1. Use the ‘Get Form’ button to access the ND DHS SFN 602 document and open it in your editor of choice.
2. Begin filling out the Staff Name section by entering the first name, middle initial, and last name of the individual requesting the ROAP ID.
3. Next, enter the Date of Birth. Ensure the format is consistent with what is required by the form.
4. Input the Date of First Hire. This is the date when the individual began their employment or service.
5. Provide the Social Security Number in the designated field. Remember, disclosure of this number is voluntary according to federal regulations, but if provided, it will aid in maintaining accurate files.
6. Fill in the HSC Telephone Number. This should be a current contact number where the individual can be reached.
7. Enter the Email Address. Ensure that it is a valid and accessible email for communication purposes.
8. Select the Staff Type by choosing one of the following options: Employee, Contract, or Student.
9. Indicate your ROAP Home RU. This is typically the location or unit you are affiliated with.
10. Next, enter the Job Title of the individual requesting the ROAP ID.
11. Provide the Supervisor's name in the appropriate field, as well as their ROAP ID.
12. If applicable, enter the NPI Number and any Licenses held by the individual.
13. Input the Medicare Provider/PTAN Number if relevant.
14. Document the Date First Licensed. This is essential for verifying qualifications.
15. Finally, ensure that a copy of the individual's license is affixed to the form via efax as requested.
16. Once all sections are completed, save your changes. You can then download, print, or share the form as needed.

Complete your ND DHS SFN 602 form online today to ensure a smooth application process.