Prescribed Form Sample Clauses

Prescribed Form. The written grievance shall be submitted on a form prescribed by the Director of Human Resources for this purpose.
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Prescribed Form. The written grievance shall be submitted on a form prescribed by the City for this purpose. Departments shall maintain an adequate supply of such forms.
Prescribed Form. The prescribed form for the statement required by this section is Form 1099. In the case of any reportable interest or dividend pay- ment as defined in section 3406(b)(2), the prescribed form is the Form 1099 re- quired in § 1.6042–4 of this chapter (re- lating to payments of dividends),
Prescribed Form. Applications for review of Organizer’s plan may be found on the City of Austin website, select the EMS Department.
Prescribed Form. Less will complete a list of requested grass permits. They will be reviewed, modified, and approved or denied by City. Commitments to sponsors and vendors SHOULD NOT be made in advance of City review of requested grass permits.
Prescribed Form. The return re- quired by this paragraph shall be made on Form 8027 with the transmittal form being Form 8027T. The informa- tion required by paragraph (a)(1)(viii) of this section may be provided by at- taching to Form 8027 photocopies of each employee’s W-2 for whom an allo- cation was made. A copy of any written good faith agreements applicable to a given calendar year (see paragraph (e) of this section) shall be attached to Form 8027 for such calendar year.
Prescribed Form. The written state- ment required by this paragraph shall be made on Form W-2.
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Prescribed Form. The information return required by this paragraph shall be made on Form 8027. The returns for the first calendar quarter of 1983 and for calendar year 1983 may be incor- porated onto a single Form 8027 but must separately set forth the required information for each of the two return periods.
Prescribed Form written response by both parties will be on the prescribed forms included in Appendix A-3, A-4 and A-5.

Related to Prescribed Form

  • Prescription Drugs The agreement may impose a variety of limits affecting the scope or duration of benefits that are not expressed numerically. An example of these types of treatments limit is preauthorization. Preauthorization is applied to behavioral health services in the same way as medical benefits. The only exception is except where clinically appropriate standards of care may permit a difference. Mental disorders are covered under Section A. Mental Health Services. Substance use disorders are covered under Section

  • Prescription Drug Plan Effective January 1, 2022, retail and mail order prescription drug copays for bargaining unit employees shall be as follows: Type of Drug Prescriptions for 1-45 Days (1 copay) Prescriptions for 46-90 Days (2 copays) Generic drug $10 $20 Preferred brand name drug $25 $50 Non- referred brand name drug $40 $80 Effective January 1, 2022, for each plan year the Prescription Drug annual out-of-pocket copay maximum shall be $1,000 for individual coverage and $1,500 for employee and spouse, employee and child, or employee and family coverage.

  • BID FORMS All bids shall be submitted on the County’s standard Bid Response Form. Modification of the Bid Response Form herein or submission of Bids on Bidder’s quotation forms shall not be accepted and shall be deemed non-responsive.

  • Prescription Glasses This plan covers prescription glasses as follows: • Frames - one (1) collection frame per plan year; • Lenses - one (1) pair of glass or plastic collection lenses per plan year. This includes single vision, bifocal, trifocal, lenticular, and standard progressive lenses. This plan covers the following lens treatments: • UV treatment; • tint (fashion, gradient, and glass-grey); • standard plastic scratch coating; • standard polycarbonate; and • photocromatic/transitions plastic. Contact Lenses (in lieu of prescription glasses) This plan covers one (1) supply of contact lenses as follows: • conventional contact lenses - one (1) pair per plan year from a selection of provider designated contact lenses; or • extended wear disposable lenses - up to a 6-month supply of monthly or two- week single vision spherical or toric disposable contact lenses per plan year; or • daily wear disposable lenses - up to a 3-month supply of daily single vision spherical disposable contact lenses per plan year. This plan also covers the evaluation, fitting, or follow-up care related to contact lenses. This plan covers additional contact lenses if your prescribing network provider submits a verification form, with the regular claim form, verifying that you have one of the following conditions: • anisometropia of 3D in meridian powers; • high ametropia exceeding -10D or +10D in meridian powers; • keratoconus when the member’s vision is not correctable to 20/25 in either or both eyes using standard spectacle lenses; and • vision improvement for members whose vision can be corrected two lines of improvement on the visual acuity chart when compared to the best corrected standard spectacle lenses.

  • Prescription Plan The PPO plan will include a comprehensive prescription 29 program:

  • Department Seniority Department seniority is defined as continuous length of service in calendar days within the employee’s department and where applicable, shall be used for internal department processes, such as vacation and schedule bids.

  • Prescription Claims against the Issuer or any Guarantor for the payment of principal or Additional Amounts, if any, on the Notes will be prescribed ten years after the applicable due date for payment thereof. Claims against the Issuer or any Guarantor for the payment of interest on the Notes will be prescribed five years after the applicable due date for payment of interest.

  • Short-Form Warning The Settling Entity may, but is not required to, use the following short-form warning as set forth in this subsection 2.3(b) (Short-Form Warning) so long as it is consistent with the implementing regulations, and subject to the additional requirements in subsections 2.5 and 2.6, as follows: WARNING: Reproductive Harm – xxx.X00Xxxxxxxx.xx.xxx or WARNING: Cancer and Reproductive Harm – xxx.X00Xxxxxxxx.xx.xxx

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