Missouri Provider Payment Details

Form Mo 886 4246N is a document that you may need to submit if you are claiming an exemption from foreign earned income. This form can be used to claim the foreign tax credit, which allows taxpayers who have paid taxes on income earned in a foreign country to claim those taxes as a deduction on their U.S. tax return. There are certain requirements that must be met in order to qualify for the foreign tax credit, so it is important to understand the rules before filing this form. If you have any questions about Form Mo 886 4246N or the foreign tax credit, please consult with a qualified accountant or tax specialist.

The following are some information regarding form mo 886 4246n. You might want to read it prior to submitting the form.

QuestionAnswer
Form NameForm Mo 886 4246N
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesmo provider payment, missouri payment resolution, missouri child request, mo child request

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STATE OF MISSOURI

DEPARTMENT OF SOCIAL SERVICES

CHILD CARE PROVIDER PAYMENT RESOLUTION REQUEST

The payment resolution process is a formal process for child care providers to have their child care payments reviewed when discrepancies occur. To initiate the review, this form must be completed by the child care provider and must be submitted within 60 days of the end of the service month in question. The attendance sheets for each child and service month listed below must be submitted with this form.

This form must also be used when a child care provider is submitting any regular invoices 60 days past the service month or 60 days past the “Return by” date found on the paper invoice, whichever is later. A statement must be included in the “Explanation” section below explain- ing why the invoices are being submitted late.

Mail all information to: Early Childhood and Prevention Services Section, Children’s Division, Attn: PRRP Unit, PO Box 88, Jefferson City, MO 65103-0088. Incomplete forms or forms submitted without attendance sheets cannot be processed and will be returned to the provider. Note: Submission of this form does not guarantee payment. ECPSS will review the request and verify the child’s and provider’s eligibility. Once the review is complete, ECPSS will notify the provider of the outcome.

CHILD CARE PROVIDER/FACILITY

DVN

CONTACT NAME

TELEPHONE NUMBER

MAILING ADDRESS

CITY

STATE

ZIP CODE

The information provided below along with the attendance sheets will be used to review payment. Attach additional sheets if more space is needed.

CHILD’S NAME

DATE OF BIRTH

DCN

SERVICE MONTH

REASON FOR

REVIEW*

 

 

 

 

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

*In the Reason for Review column, enter the letter that best describes the situation:

A - This child was not on my invoice.

B - The rates on my invoice were incorrect.

C - I provided more units of care than the child was authorized.

D - I was not paid for the units I submitted on my invoice.

E - Other; explain in space below.

EXPLANATION

PROVIDER SIGNATURE

DATE

MO 886-4246N (2-06)

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