Get Ny Related Service Billing Form 7a - New York City 2020-2025

Completing the NY Related Service Billing Form 7A is essential for accurately billing related services in New York City. This guide provides a clear, step-by-step process for filling out the form online, ensuring all necessary information is included for timely processing.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Section 1: Student Information. Fill in the date of birth, student name, related service, service district, NYC ID number, IEP recommendation, hourly rate, frequency, duration, language, group size, and indicate if a DOE platform was used for the services.
3. Proceed to Section 2: Provider Information. Enter the provider's social security number, name, address, email address, and telephone number.
4. Next, complete Section 3: Agency Information. Provide the agency name, federal tax ID number, address, telephone number, and email address.
5. Move on to Section 4: Service Provision. Fill out each date of service, frequency, start time, end time, group size, and delivery mode (select audio only or audio & video). Complete the total number of sessions, the rate, and the total amount due.
6. Finally, in Section 5: Provider Certification/Parent Verification, certify the services provided, include the parent/guardian's email or phone number, date received, provider signature, and provider name and date.
7. Ensure the parent/guardian reviews the information and checks the appropriate method of verification (email or phone).
8. After completing the form, you can save changes, download, print, or share the form as needed.

Take action now and complete your NY Related Service Billing Form 7A online.