Participant Information My address is: My Social Security Number is:
Sharing of Participant Information 22 7.4 REPORTING AND DISCLOSURE AND COMMUNICATIONS TO PARTICIPANTS............................22 7.5 NON-TERMINATION OF EMPLOYMENT; NO THIRD-PARTY BENEFICIARIES............................23 7.6
Tenant Information Copies of the Leases and any financial statements or other financial information of any tenants under the Leases (and the Lease guarantors, if any), written information relative to the tenants’ payment histories, and tenant correspondence, to the extent Seller has the same in its possession;
APPLICANT INFORMATION We are a child safe and equal opportunity employer. Applications from Aboriginal and Xxxxxx Xxxxxx Islander people, people with a disability and people from culturally and linguistically diverse backgrounds are encouraged. In addition, applications for positions that work with children must provide referees who can comment on their experience working with children. These roles also require a valid
Other Important Information Collection costs You agree to pay our reasonable costs for collecting amounts due, including reasonable attorneys’ fees and court costs incurred by us or another person or entity, to the extent not prohibited by applicable law and except as provided below.
Other Relevant Information This information shall always be in writing and shall address other relevant information as required by the contract or requested by the RFP. For example, in accordance with Section H, H106, Avoidance of Organizational Conflicts of Interest, identifying any situation in which the potential for a conflict of interest exists. If travel is specified in the TO PWS or statement of work, air fare and/or local mileage, per diem rates by total days, number of trips and number of contractor employees traveling shall be included in the cost proposal (see clause H047).
Disclosure of Account Information to Third Parties We will disclose information to third parties about your account or the transfers you make:
Compensation for Providing Information The Party requesting information agrees to reimburse the other Party for the reasonable costs, if any, of creating, gathering, copying, transporting and otherwise complying with the request with respect to such information (including any reasonable costs and expenses incurred in any review of information for purposes of protecting the Privileged Information of the providing Party or in connection with the restoration of backup media for purposes of providing the requested information). Except as may be otherwise specifically provided elsewhere in this Agreement, any Ancillary Agreement or any other agreement between the Parties, such costs shall be computed in accordance with the providing Party’s standard methodology and procedures.
ADDITIONAL GRANT INFORMATION Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Xxxxx Xxxxxx SIGNATURE PAGE FOR SYSTEM AGENCY CONTRACT NO. HHS000663700189 HEALTH AND HUMAN SERVICES COMMISSION THE GULF COAST CENTER Assoc. Commissioner IDD/BH Date of execution: _July 29, 2020 Xxxxxxx Xxxxxx CEO Date of execution: July 29, 2020 THE FOLLOWING ATTACHMENTS TO SYSTEM AGENCY CONTRACT NO. HHS000663700189 HEREBY INCORPORATED BY REFERENCE: ATTACHMENT A STATEMENT OF WORK ATTACHMENT A-1 STATEMENT OF WORK SUPPLEMENTAL ATTACHMENT A-2 SUBSTANCE ABUSE PREVENTION AND TREATMENT (SAPT) BLOCK GRANT CONTRACT SUPPLEMENTAL ATTACHMENT B PROGRAM SERVICES & UNIT RATES ATTACHMENT C GENERAL AFFIRMATIONS ATTACHMENT D UNIFORM TERMS AND CONDITIONS-GRANTEE ATTACHMENT E SPECIAL CONDITIONS VERSION 1.2 ATTACHMENT F FEDERAL ASSURANCES AND CERTIFICATIONS ATTACHMENT G DATA USE AGREEMENT VERSION 8.5 ATTACHMENT H FISCAL FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA) FORM ATTACHMENT I SYSTEM AGENCY SOLICITATION NO. HHS0006637 INCLUDING ANY CLARIFICATIONS OR MODIFICATIONS MADE IN RESPONSE TO QUESTIONS SUBMITTED DURING POSTING AND ANY ADDENDUM ATTACHMENT X XXXXXXX’S PROPOSAL FOR SOLICITATION NO. HHS0006637 ATTACHMENTS FOLLOW ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR FEMALES SECTION I: PURPOSE Grantee shall provide Substance Use Disorder Treatment Services for one (1) or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.
Participant Acceptance Participant must accept the terms and conditions of this Agreement either electronically through the electronic acceptance procedure established by the Company or through a written acceptance delivered to the Company in a form satisfactory to the Company. In no event shall any Shares be issued (or other securities or property distributed) under this Agreement in the absence of such acceptance.
