PDF-PHS 6031 (Rev. 06/15) Page 1 Form Approved Through 10/31/2018 OMB No.

Author : pasty-toler | Published Date : 2016-07-07

COMPLETED FORM SHOULD BE MAILED TO THE AWARDING FEDERAL AGENCY GRANTS MANAGEMENT OFFICE NAMED IN THE NOTICE OF AWARD THIS AGREEMENT IS A REQUIRED CONDITION OF AWARD

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PHS 6031 (Rev. 06/15) Page 1 Form Approved Through 10/31/2018 OMB No.: Transcript

COMPLETED FORM SHOULD BE MAILED TO THE AWARDING FEDERAL AGENCY GRANTS MANAGEMENT OFFICE NAMED IN THE NOTICE OF AWARD THIS AGREEMENT IS A REQUIRED CONDITION OF AWARD a payback obligation Under t. 31012007 I am giving you notice that I am terminating my tenancy The last day of my tenancy will be daymonthyear A tenant must give the landlord this notice as follows I will move out of the rental unit on or before this date If the tenancy is a da AD-A252 270 FATION PAGE cMB No. 0704 -0188 ge I~ uour oer resorse. including tile time for reviewing instructions. searchng existing cata sourcf- .. 'r, P o0 'llecicon of information Send Commintsr al Page 1 – When a law practice ceases Regulation 3.3.48 Legal Profession Regulations 2005 The period covered by this report From: / / To: / / Name of law practice: Entity No: E Addre WORK. . After a Trade Related Layoff. Trade Adjustment Assistance. You. . are eligible to apply for Adjustment . A. ssistance.. Totally or partially separated from employment on or after (insert impact date).. Form Approved OMB No. 0704 - 0188 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time fo r reviewing instructions, searching exis 1. ( Complete Section IV. ) Have been engaged in continuous payback service during reporting period.(Complete Sections II, III, and IV.) I certify that all of the above statements are true, complete, REPORT DOCUMENTATION PAGE OMB No. 074-0188 Public reporting burden for this collection of information is estimated to average i hour per response, including the time for reviewing instructions, search Form Approved OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching exist Page 1 of 4 * required for saving **required for completion Facility ID: Event #: *Patient ID: Social Security #: Secondary ID: Medicare #: Patient Name, Last: First: Middle: *Gender: F M Ot By pasting the address at the bottom of this page in your address box at the top of your browser, you can access INDOT’s Indiana Technical Assistance Program (ITAP). The page, as it appears, is shown below. . Fall 2018 Applicant Training . 1. AGENDA. Preparing for Invoicing . Invoicing Methods. Before You Begin. Filing FCC Form 498. When to File / Deadlines. Invoice Review Process. Case Studies. © 2018 . The Nuts and Bolts of Work & Community Engagement Requirements. November 13, 2018. Status of Community Engagement Requirements in the States. National Association of Medicaid Directors. 2. Arkansas. Please complete this form and return to the officeFull NameDateAddressPenalty AmountReason for Waiver:SignatureDate:Office ManagerBoardto Fill in BelowApproved: ______________ E-Enterprise Conference . October 24,2018. 3:45 pm to 5:30 pm. 10/17/2018. 1. Presentation Objectives. 1. Overview of MOSAIC, Tom Wible, CGI Federal. Description. 3 Solution Components. 3 Levels of Customization.

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