Get Ny Pas 123 2014

Filling out the NY PAS 123 form is essential for applicants seeking a waiver after undergoing fingerprinting for the New York State Office of Alcoholism and Substance Abuse Services. This guide provides clear instructions on completing the form accurately and efficiently.

Follow the steps to complete the NY PAS 123 form online

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the applicant's name in the designated field. Ensure the spelling is correct to avoid any processing delays.
3. Input the date of birth in the specified format, making sure to double-check the accuracy of the date entered.
4. Provide the applicant's Social Security number in the corresponding field. This information is sensitive; handle it with care.
5. Indicate the provider requesting the waiver. Clearly print or type the name of the organization in the provided space.
6. If applicable, answer the question regarding dually licensed providers by marking either 'Yes' or 'No'.
7. Fill in the position or job title of the applicant within the organization. This helps identify the role related to the waiver request.
8. Enter the date when the applicant was last fingerprinted. This date is crucial for tracking compliance with fingerprinting regulations.
9. Specify the agency or provider that the applicant was fingerprinted for. Incorrect information may lead to issues in processing the request.
10. If you are requesting a waiver, remember not to schedule the applicant for fingerprinting with MorphoTrust unless advised by OASAS.
11. In the section for notes and comments, add any additional information that may support the waiver request.
12. Complete the certification of provider section by providing the signature, date, name, title, and email address of the signing provider.
13. Once all fields are completed, review the form for any errors or omissions. After confirming accuracy, you can save the changes to your document.
14. Download, print, or share the completed form as necessary before submitting it via email to OASAS at cbc@oasas.ny.gov.

Start completing the NY PAS 123 form online today to ensure timely processing of your waiver request.