Get Wa Dshs 27-122 2015
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How to fill out the WA DSHS 27-122 online
Filling out the WA DSHS 27-122 form is an essential step for individual providers seeking to contract with the Department of Social and Health Services. This guide provides a clear and comprehensive approach to assist you in completing the form accurately and efficiently.
Follow the steps to successfully complete the WA DSHS 27-122 form.
- Click the ‘Get Form’ button to access the WA DSHS 27-122 form and open it in your preferred online editor.
- Begin with Part A, where you will provide your individual provider information. Fill in your contractor name as it appears on your Social Security card. Ensure to include your home and mailing addresses, and any additional addresses if applicable.
- For identification purposes, you must provide information regarding your unexpired picture ID and Social Security card. Ensure that the names match reasonably.
- Complete the specific client information section if you will provide services to a specific individual by stating their name.
- Answer the suitability questions honestly. If you have any suspensions or debarments, you will need to respond accordingly and attach additional documentation if necessary.
- If applicable, list any previously held Social Service Payment System provider numbers, providing specific details about the service types you previously offered.
- Detail any current or previous contracts you've had with the State of Washington over the last five years, if any.
- Complete Part B by indicating whether you are a current or former state employee. Provide the termination date if applicable.
- If you answered yes to the previous question regarding state employment, it is necessary to complete Part C, the Ethics Certification, ensuring compliance with the ethical standards required.
- Review all information entered for accuracy. Once complete, you can save your changes, download, print, or share the form as needed.
Start filling out your WA DSHS 27-122 form online today to move forward with your contracting process.
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Renewing your SNAP benefits in Washington state requires you to fill out a renewal application, which you can find on the WA DSHS 27-122 site. Ensure that you submit your application before your benefits expire for uninterrupted support. Keep in mind that you may need to provide updated verification documents related to your income. Uslegalforms provides templates and tools that can simplify this renewal process.
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