Get 2426.doc. Dads Provider Services Information Letter No. 06-105 Submission Of The Hospice Election

Filling out the 2426.doc form is an essential process for submitting information related to the Medically Dependent Children Program. This guide provides step-by-step instructions to assist users in completing the form accurately and efficiently.

Follow the steps to complete the 2426.doc form accurately.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering the individual’s name and date of birth in the designated fields. Ensure that the information is accurate and up to date.
3. Indicate whether the request is for an extension on a case that is not yet overdue by selecting 'Yes' or 'No'. If 'Yes', provide the due date for the case.
4. For overdue cases, list the most recent IPC dates by filling in the 'From' and 'To' dates in the provided fields.
5. Next, indicate if an extension has been granted by selecting 'Yes' or 'No' in the corresponding section.
6. Provide a detailed explanation of any delays encountered in the initial case under 'Explanation of Delay'. This should describe any challenges faced.
7. Fill in the status of initial or renewal activities in the table provided. Include the actual or anticipated date of submission and a brief reason for any delays.
8. Indicate the status of determination for each item by selecting from the options available, and include the date received for clarity.
9. Finally, include the date of planned follow-up contact and ensure that all information is reviewed for accuracy.
10. Once all fields are completed, save your changes. You may then download, print, or share the form as needed.

Begin filling out the 2426.doc form online today to submit your information accurately.