Do you ever feel overwhelmed when filing your taxes? Tax season can be daunting, but there are plenty of resources to help make the process easier. One such resource is Form DMA 5118, a California state tax form that can help you claim certain deductions. In this blog post, we'll provide an overview of what Form DMA 5118 is and how to complete it. We'll also discuss some of the deductions that are available on this form. So if you're looking for help navigating California's tax system, keep reading!
| Question | Answer |
|---|---|
| Form Name | Form Dma 5118 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | DMA-5118, Handout, dma 5118a form, completing |
Handout 4
MEDICAID TRANSPORTATION
VERIFICATION OF RECEIPT OF MEDICAID COVERED SERVICE
TO: Medicaid Enrolled Provider
From: ___________________________ County Department of Social Services
When transportation assistance is provided to a Medicaid recipient, for audit purposes, it is necessary to document that the individual received a Medicaid covered service from a Medicaid- enrolled provider on the date of transport. Please complete the following:
This is to certify that __________________________________ visited this office or facility on
(Medicaid recipient’s name/Medicaid ID Number)
_________________________ and received a Medicaid covered service.
(date)
Name of Medicaid provider/facility: _______________________________________________
Signature of person completing form on behalf of provider: ____________________________
MEDICAID TRANSPORTATION
VERIFICATION OF RECEIPT OF MEDICAID COVERED SERVICE
TO: Medicaid Enrolled Provider
From: ______________________ County Department of Social Services
When transportation assistance is provided to a Medicaid recipient, for audit purposes, it is necessary to document that the individual received a Medicaid covered service from a Medicaid- enrolled provider on the date of transport. Please complete the following:
This is to certify that __________________________________ visited this office or facility on
(Medicaid recipient’s name/Medicaid ID Number)
_________________________ and received a Medicaid covered service.
(date)
Name of Medicaid provider/facility: _______________________________________________
Signature of person completing form on behalf of provider: ____________________________