FINANCIAL INSTITUTION INFORMATION. Financial Institution Name: Enter your Financial Institution’s name (this is the name of the bank or qualifying depository • that will receive the funds).
FINANCIAL INSTITUTION INFORMATION. Financial Institution Name* Official name of the provider’s financial institution. Financial Institution Routing Number* A 9-digit identifier of the financial institution where the provider maintains an account to which payments are to be deposited. Enter the number twice for validation. Provider’s Account Number With Financial Institution* Provider’s account number at the financial institution to which EFT payments are to be deposited. Enter the number twice for validation. Type of Account at Financial Institution* Check the type of account funds are to be deposited to. Enter the number twice for validation. Account Number Linkage to Provider Identifier (Select one and Fill in the Number) Provider preference for grouping (bulking) claim payments – much match preference for v5010X12835 remittance advice. NOTE: EFT data will always be linked by the MO HealthNet trading partner ID related to the NPI/taxonomy.
FINANCIAL INSTITUTION INFORMATION. Line 8: Enter your Financial Institution’s name (this is the name of the bank or qualifying depository that will receive the funds). Note: The account name to which EFT payments will be paid is to the name submitted on Part II of this form. Line 9: Enter the street address where your financial institution is located. Line 10: Enter the city, state, and zip code where your financial institution is located. Line 11: Enter the telephone number of your financial institution. Line 12: Enter the name of your account representative or contact person. Line 13: Enter the routing number for your financial institution. Line 14: Enter the account type. Line 15: Enter the deposit account number. If you do not submit this information, your EFT authorization agreement will be returned without further processing.
FINANCIAL INSTITUTION INFORMATION. Name of Financial Institution Address (Routing/Transit No.) (Checking or Savings Account No.) Please enclose a voided check or deposit slip
FINANCIAL INSTITUTION INFORMATION o First Submission o Change in ________________________________________ Information Name of Bank
FINANCIAL INSTITUTION INFORMATION. Must be present when requesting direct debit or deposit. 🞏 Foreign Account Deposit/Debit: See instructions below. TYPE OF ACCOUNT ROUTING NUMBER 🞏 Checking 🞏 Savings ACCOUNT NUMBER
FINANCIAL INSTITUTION INFORMATION. Section - Financial institution prints or types the name and address of the payee/company's financial institution who will receive the ACH payment, ACH coordinator name and telephone number, nine-digit routing transit number, depositor (payee/company) account title and account number. Also, the box for type of account is checked, and the signature, title, and telephone number of the appropriate financial institution official are included. Burden Estimate Statement The estimated average burden associated with this collection of information is 15 minutes per respondent or record keeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to the Financial Management Service, Facilities Management Division, Property and Supply Branch, Room B-000, 0000 Xxxx Xxxx Xxxxxxx, Xxxxxxxxxxx, XX 00000 and the Office of Management and Budget, Paperwork Reduction Project (1510-0056), Washington, DC 20503. ATTACHMENT J-13 REQUIRED TRAINING The Ship Manager shall ensure that the training listed below is accomplished in addition to regulatory requirements. The “Personnel” column indicates the minimum requirement; additional personnel can be trained by request. If ROS crewmembers are to cover the training they shall be trained before the ship is declared “Ready for Sea” on activation. Therefore, plan to provide emergent training to cover a crew member that is waiting for a scheduled training offering. If it’s expected that new crewmembers arriving for activation are to cover the requirement, they shall be trained before the ship is declared “Ready for Sea”. Notify the COTR of training deficiencies during ship activation and indicate how deficiencies are being corrected for reporting in the Activation SITREPs. Periodically, verify the times that MSC provided training is available so activations are not delayed. Training sources are not limited unless indicated below in “Restrictions”, provided that authorized certificates are given. Request source lists from the COTR when courses are restricted to approved providers. Make requests to the COTR in advance of when MARAD provided training is needed. MSC may provide addition training that is not listed after coordinating with the COTR. Check (xxxx://xxxxxx.xxxxxxxxxxxxxx.xxx/training/) for additional training information. Drawdown on the crew are allowed for training but a smaller crew size does not relieve the Ship Manager from ...
FINANCIAL INSTITUTION INFORMATION. Section - Financial institution prints or types the name and address of the payee/company's financial institution who will receive the ACH payment, ACH coordinator name and telephone number, nine-digit routing transit number, depositor (payee/company) account title and account number. Also, the box for type of account is checked, and the signature, title, and telephone number of the appropriate financial institution official are included. Burden Estimate Statement The estimated average burden associated with this collection of information is 15 minutes per respondent or record keeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to the Financial Management Service, Facilities Management Division, Property and Supply Branch, Room B-000, 0000 Xxxx Xxxx Xxxxxxx, Xxxxxxxxxxx, XX 00000 and the Office of Management and Budget, Paperwork Reduction Project (1510-0056), Washington, DC 20503. ATTACHMENT J-12 AWARD TERM INCENTIVE OPTION PLAN AWARD TERM INCENTIVE OPTION PLAN (ATIOP) For Ready Reserve Force (RRF) Ship Manager Contracts Awarded Under Solicitation DTMA8R04004 Approved by Term Determining Official Procuring Contracting Officer TABLE OF CONTENTS PART I - INTRODUCTION A. Overview
FINANCIAL INSTITUTION INFORMATION. Financial Institution's Name Financial Institution's Street Address Financial Institution's City Financial Institution's Location State Financial Institution's Zip Code Financial Institution's Telephone Number Financial Institution's Contact Person Financial Institution Routing Number Provider's/Supplier's/IPP Entity's Account Number with Financial Institution Type of Account (check one) Checking Account Savings Account
FINANCIAL INSTITUTION INFORMATION. □ □ Name of Bank Address City State Zip Telephone Number of Bank Account Information (check one) Checking Savings Bank Transit / Routing Number (Ask bank for the transit/routing number for direct deposit)
