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DD Revenue Support Field Office (see the OPWDD website at www.opwdd.ny.gov for a list). Incomplete forms or forms lacking required documentation will not be processed and will be returned to the provider. Name of Person Receiving Services: Service Provider: TABS ID #: Service Provider Tax ID Number: TABS Agency Code: Service Provider Contact: Service Provider Address: Type of Service(s): OPWDD TABS Program Code(s): Type of Authorization Being Requested: Fee Reduction Fee Waiver Reason For Reque.
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