Every year, as required by law, businesses large and small must file IRS Form Fa 24. This information is used to calculate how much each business owes in taxes. While it can seem like a daunting task, with the help of a professional accountant, it's a process that can be completed relatively easily. Here we'll outline what information is required on Form Fa 24, and what penalties you could face if you don't submit it on time.
Here, you'll find a number of details about form fa 24 PDF. This site can provide specifics of the form's size, finalization duration, and the parts you can be expected to fill.
| Question | Answer |
|---|---|
| Form Name | Form Fa 24 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | pv10, PCS, FA-24-I, FA-24 |
HP Enterprise Services - Nevada Medicaid and Check Up
Functional Assessment Request for Personal Care Services (PCS)
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Fax to: (775) |
Questions? Call: (800) |
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DATE OF REQUEST: _____ /______ /______ |
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REQUESTER NAME: |
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PURPOSE OF REQUEST |
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Initial Visit* |
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Transfer Provider |
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Cancel Authorization |
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Transfer Start Date: |
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Cancellation Date: ______/______/________ |
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Update Visit (Q year)*** |
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____/______/_________ |
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Reason: |
Recipient Ineligible |
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One Time Service |
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Recipient Expired |
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Other: _____________________ |
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RECIPIENT INFORMATION |
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Last Name, First Name, Middle Initial: |
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Recipient ID: |
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Translator Required |
Language: |
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SSN: |
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DOB: |
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Address: |
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GUARDIAN INFORMATION |
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Guardian Name (if applicable): |
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Relationship to Recipient: |
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Guardian Address: |
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PCS AGENCY INFORMATION |
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PCS Agency Name: |
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API: |
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REFERRAL INFORMATION |
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Contact Name: |
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REASON FOR REQUEST (Required for Initial Visits,
Description of service and recipient needs (has homemaker, surgery scheduled, etc.):
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*Initial Visit: The recipient has no current functional assessment or service plan.
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***Update Visit: The yearly review of a recipient’s service plan and functional assessment. A new Authorization Number is given to the provider.
For assistance with this form, see instructions online at http://www.medicaid.nv.gov (select “Forms” from the “Providers” menu, then click on Form Number
The information contained in this form, including attachments, is privileged and confidential and is only for the use of the individual or entities named on this form. If the reader of this form is not the intended recipient or the employee or agent responsible to deliver it to the intended recipient, the reader is hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If this communication has been received in error, the reader shall notify sender immediately and shall destroy all information received. This referral/authorization is not a guarantee of payment.
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03/07/2012 pv10/01/2011 |
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