Get Nd Sfn 546 2019

The ND SFN 546 is a crucial form for submitting reimbursement requests for the Lifespan Respite Care Grant. This guide provides clear, step-by-step instructions to help users navigate the online completion of this form effectively.

Follow the steps to successfully complete the ND SFN 546 online

1. Click ‘Get Form’ button to access the ND SFN 546, which will open the form in the online editor.
2. Complete Section 1: Provider Information by filling in your name, telephone number, the month and year of the billing period, and your address, including city, state, and ZIP code.
3. Move on to Section 2: Caregiver/Care Recipient Information. Enter the caregiver's name and the care recipient's name.
4. Document the details of service provided by entering the date, the number of hours or days of respite service, start time, and end time.
5. Calculate the total amount requested based on the established hourly or daily rate, ensuring that the total hourly amount does not exceed the allowable maximum daily rate.
6. In Section 3: Certification and Agreement of Agency Providers, read the certification statement thoroughly. Check the box and type your name to electronically sign the document.
7. Ensure all information is accurate and complete before proceeding to save changes, download, or print the form.
8. Finally, submit the completed form via email by clicking the designated button to send it to carechoice@nd.gov within 60 days from the first day of service.

Take the next step in your application process by submitting your ND SFN 546 online.