Get Sd Dss-nemt-952 2021-2026

This guide provides a clear and comprehensive overview of how to fill out the SD DSS-NEMT-952 Non-Emergency Medical Travel Payment Authorization Form online. By following the steps outlined below, users can efficiently complete the form to ensure their non-emergency medical transportation payments are processed correctly.

Follow the steps to fill out the SD DSS-NEMT-952 form accurately.

1. Click the ‘Get Form’ button to access the SD DSS-NEMT-952 form and open it in your preferred editor.
2. Read through the entire form before filling it out to understand the information required. Ensure that you have all necessary details on hand, including personal identification, banking information, and any previous NEMT Payment Authorization forms if applicable.
3. In the 'Payee Information' section, enter your full name as an adult. Make sure to indicate if you are Mr., Mrs., or Ms. Fill in your mailing address, city, state/zip code, and provide your primary and alternate telephone numbers.
4. Input your date of birth and Social Security Number or Tax ID Number in the designated fields.
5. Under 'Electronic Payment Options', select either 'Direct Deposit' or 'NEMT Payment Card (Debit Card)'. This choice dictates how you will receive your payments.
6. If you selected 'Direct Deposit', fill in your bank's name, routing number, account number, and specify whether your account is a checking or savings account. Remember to attach a voided check or a formal bank letter confirming your account details.
7. Review all information entered for accuracy and completeness to avoid any processing delays. Make any necessary corrections before finalizing your submission.
8. Sign and date the form at the designated signature field. This step is crucial as it authorizes the Department of Social Services to process your payment.
9. Once completed, mail, fax, or email the form to the provided contact information: DSS - EBT/NEMT, 700 Governors Drive, Pierre, SD 57501-2291, Phone: 1-866-403-1433, Fax: 605-773-8461, Email: dss.ebtstateoffice@state.sd.us.

Start filling out your SD DSS-NEMT-952 form online today!