Get 003735135.doc - Services Dpw State Pa

This guide provides easy-to-follow instructions for filling out the 003735135.doc - Services Dpw State Pa form online. Whether you are familiar with digital forms or this is your first experience, our step-by-step guide will ensure that you complete the form accurately and efficiently.

Follow the steps to successfully fill out the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the online editing platform.
2. Begin by entering the provider name and address in the designated fields. Make sure to provide complete and accurate information.
3. List the names of all recipients involved in the case. Ensure that each name is clearly printed to avoid any confusion.
4. Fill out the department representative's name and contact information accurately to facilitate communication.
5. Enter the case number and relevant dates, including the date the adverse action was mailed and the date the scheduling notice was sent.
6. Complete the sections for BHA docket numbers and issue codes as specified in the form. Review all codes for correctness.
7. If applicable, document any witnesses for both the provider and department. Provide their names clearly under the appropriate sections.
8. Specify the date of the hearing, along with the start and end times. Make sure to note any additional relevant information.
9. Review the order section carefully, ensuring that it reflects the decisions made and follows established protocols.
10. Once all sections are completed, save the form to your device. You can then download, print, or share the document as needed.

Complete your documents online to ensure a smooth submission process.