Provider Certification. A. The Contractor shall comply with California Code of Regulations, title 9, section 1810.435, in the selection of providers and shall review its providers for continued compliance with standards at least once every three years.
Provider Certification. The manager/designee and employee is responsible for the 4 proper administration of the sick leave benefit. Verification from a licensed health care provider may 5 be reasonably required to substantiate the health condition of the employee or family member for 6 leave requests.
Provider Certification. The employee provides written proof from an 6 accredited medical institution, organization or individual as to the need for the employee to donate 7 bone marrow, a kidney, or other organs or tissue or to participate in any other medical procedure 8 where the participation of the donor is unique or critical to a successful outcome.
Provider Certification. A. Individual, group, and organizational service providers who contract with County to provide Medi-Cal reimbursed services must be certified for participation in the Medi-Cal program. To receive/maintain Medi-Cal certification, providers must meet minimum standards as specified in Title 9, Division 1, Chapter 11, Subchapter 1, Article 4, Section 1810.435. Included in the standards are specific areas of compliance including the requirement to meet the Quality Management Program Standards and any additional requirements established by the Mental Health Plan (MHP) as part of a credentialing or other evaluation process (Title 9, Division 1, Chapter 11, Subchapter 1, Article 4, Section 1810.435, (5), (6)). For organizational providers, the MHP certification process shall include an on-site review in addition to a review of required documentation. All providers are required to notify the MHP 45 days prior to any of the following: (1) organizational and/or corporate change; (2) change in provider's license to operate;
Provider Certification. Each disclosure and each receipt of Health Data by Subscribed User through Direct Service shall constitute a certification by Participant that Participant and Subscribed Users are complying with this Agreement.
Provider Certification. I declare under penalty of perjury that the above information is true and that these children were provided services at the above location and on the days and times listed above. I understand that I must repay any overpayment resulting from false or incorrect information and that I may be prosecuted for fraud. Director/Owner Signature Date DHS 9800 A2D (7/1/2007) **Parent signature is required as disclosed in the 9800 agreement for payment of vouchers. Daily Attendance Form Example DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILDCARE & EARLY CHILDHOOD EDUCATION WEEKLY CHILD ATTENDANCE FORM Facility Name Facility Number Week of Parent/Guardian/Authorized Representative Certification of Attendance: By my signature below, I declare under penalty of perjury that the information is true and that my child was provided services at the above location and on the days and times listed below. I understand that I must repay any overpayment resulting from false or incorrect information and that I may be prosecuted for fraud. Child's Name TIME Sunday Monday Tuesday Wednesday Thursday Friday Saturday Parent Signature** Date 1 INOUT 2 INOUT 3 INOUT 4 INOUT 5 INOUT 6 INOUT 7 INOUT 8 INOUT 9 INOUT 10 INOUT 11 INOUT Provider Certification: I declare under penalty of perjury that the above information is true and that these children were provided services at the above location and on the days and times listed above. I understand that I must repay any overpayment resulting from false or incorrect information and that I may be prosecuted for fraud. **Parent signature is required as disclosed in the 9800 agreement for payment of vouchers. DHS 9800 A2W (7/1/2007) Director/Owner Signature Date ARKANSAS DEPARTMENT OF HUMAN SERVICES CHILD CARE AND DEVELOPMENT FUND (CCDF) PROGRAM PARTICIPANT AGREEMENT
Provider Certification. A. The Contractor shall comply with Cal. Code Regs., tit. 9, section 1810.435, in the selection of providers and shall review its providers for continued compliance with standards at least once every three years.
Provider Certification. Provider represents and warrants that Provider has not been convicted of bribing or attempting to bribe an officer or employee of the State, nor has Provider made an admission of guilt of such conduct that is a matter of record.
Provider Certification. I hereby request approval of this Ignition Interlock Service Provider Authorization Agreement, which I have read in its entirety, and with the knowledge and understanding that the IISP must abide by its provisions at all times. I certify that all of the application information previously furnished by the IISP, as well as all additional information set forth herein by the IISP, is true and accurate, and that any records or information obtained by the IISP hereunder will be used solely for the purposes specified in this Authorization Agreement, and for no other purposes. I further certify that I have the authority to execute this written Agreement. Name of Manufacturer IISP Signature IISP Name Printed Date FOR MVD USE ONLY Received this date Signed AUTHORIZATION On behalf of the Arizona Department of Transportation, Motor Vehicle Division, the Ignition Interlock Service Provider authorization requested by {Name of Provider] pursuant to this Agreement is hereby approved. DATED THIS DAY OF , 20 Xxxx X. Xxxxxxxxx
Provider Certification. (To be Completed by the Child Care Provider) To the best of my knowledge, I certify that:
