HHS forms are used every day to perform tasks such as applying for benefits, contracting to provide goods or services, reporting incidents, declaring end of life wishes, and conducting other business.

Contracting Entity Registration Form to report any changes to the information submitted in the form no later than the 30th day after the day the change takes effect. This requirement is necessary for TDI to have current name and contact information for the contracting entity, which is required under Insurance Code §1458.052. A 30-day period

This form notifies the fire marshal or state fire marshal that there has been a determination that a specific resident is inappropriately placed, and the resident no longer meets all

Complete pages 1-5 of this form. You are responsible for the information on your return. Provide complete and accurate information. If you have questions, ask the IRS-certified volunteer preparer. Volunteers are trained to provide high quality service and …

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This form furnishes a standardized format for long-term care (LTC) providers to document their self-reported incident investigation summary, analysis and finding(s) per regulatory requirements. Procedure. After making a verbal report to 800-458-9858, submit Form 3613-A, Provider Investigation Report.

This subsection provides instructions to the assigned TCS for preparing estate or gift tax computations for a notice of deficiency. Use Form 3614-A for estate tax cases and Form 3615-A for gift tax cases.

The 10-working day time frame begins the day the facility receives the "Statement of Licensing Violations and Plan of Correction" (Form 3724) and the report of contact (Form 3614-A). Regulatory Services reviews the documentation submitted by the ALF, and, as long as the ALF submitted all required documentation within the time frames, the ...

The 10-working day time frame begins the day the facility receives the "Statement of Licensing Violations and Plan of Correction" (Form 3724) and the report of contact (Form 3614-A). Regulatory Services reviews the documentation submitted by the ALF, and, as long as the ALF submitted all required documentation within the time frames, the ...