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[DOC File]Share of Cost (SOC) (share) - Medi-Cal
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Share of Cost Some subscribers may have had their SOC incorrectly determined. Medi-Cal Provider Letter In these cases the subscriber will receive a Notice of Action or a (MC 1054) Share of Cost Medi-Cal Provider Letter (MC 1054) from the county showing the change in SOC obligation for the affected month(s) or year(s).
[DOCX File]Performance Evaluation Template - UCLA
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Time in Position: 1 Year or more . Less than 1 Year years months. RATING CATEGORIES: Exceptional Performance (outstanding achievements that far exceed goals in all performance elements) Exceeds Expectations (performance that consistently goes beyond meeting goals) Fully Meets Expectations (commendable performance that meets goals)
[DOC File]Data Assessment Plan (DAP) Note - HIV Prevention HPCPSDI
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Data Assessment Plan (DAP) Note. CLIENT/ID: Date: Counselor’s Initials: A DAP note is to be filled out each time you meet with a client for a CLEAR session. Please use the questions and statements listed below each section as a guide to what information needs to be included in order to ensure that this note is a complete explanation of the ...
[DOC File]SEWAGE FLOW RATE ESTIMATING GUIDE - Pollution Control …
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(Range and Typical are shown in gallons per unit) Estimates are based on US standards for water usage and sewage strength. Typical Wastewater Flow Rates from Commercial Sources
[DOC File]COMPUTER-USER AGREEMENT
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When a banner is used, the banner functions to remind the user of the conditions that are set forth in this User Agreement, regardless of whether the banner describes these conditions in full detail or provides a summary of such conditions, and regardless of whether the banner expressly references this User Agreement.
[XLS File]Percent of Time & Effort to Person Months (PM) Interactive ...
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Percent of Time & Effort to Person Months (PM) Interactive Conversion Table A PI on an AY appointment at a salary of $63,000 will have a monthly salary of $7,000 (one-ninth of the AY). $15,750 (7,000 multiplied by 2.25 AY months). A PI on a CY appointment at a salary of $72,000 will have a monthly salary of $6,000 (one-twelfth of total CY salary).
[DOCX File]Example employee notice form
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This document contains important information about your employment. Check the box at left to receive this information in this language.
[DOC File]BILL OF SALE
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A bill of sale form is provided if the buyer of a vehicle wants documentation of the sale and/or the seller wishes a receipt of the sale. This form should be completed in ink: seller’s name. make of the vehicle (chevy, ford, dodge, etc.) year of the vehicle. vin # - vehicle identification number. buyer’s name.
[DOC File]Sample Memorandum of Understanding Template
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Title: Sample Memorandum of Understanding Template Subject: CDC developed this publication, Collaboration Guide for Pacific Island Cancer and Chronic Disease Programs (or the Pacific Island Collaboration Guide), to help CCC programs and coalitions and other chronic disease and school-based programs and coalitions work together.
[DOC File]P11 Form : United Nations Personal History Form
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I understand that any misrepresentation or material omission made on a Personal History form or other document requested by the Organization renders a staff member of the United Nations liable to termination or dismissal.
[DOC File]SUICIDE RISK ASSESSMENT GUIDE - Mental Health Home
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REFERENCE MANUAL. INTRODUCTION. The Suicide Risk Assessment Pocket Card was developed to assist clinicians in all areas but especially in primary care and the emergency room/triage area to make an assessment and care decisions regarding patients who present with suicidal ideation or provide reason to believe that there is cause for concern.
[DOC File]SAMPLE CORPORATE RESOLUTION - Office of the Texas …
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CORPORATE RESOLUTION CERTIFICATE OF CORPORATE RESOLUTION. AUTHORIZING ENTERPRISE PROJECT APPLICATION. I, , President of , organized and existing under the laws of and having its principal place of business at , hereby certify that the following is a true copy of a resolution adopted by the Board of Directors of the Corporation at a meeting convened and held on at which a …
[DOT File]OCFS-4622
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OCFS 4622 (12/2010) NEW YORK STATE. OFFICE OF CHILDREN AND FAMILY SERVICES. DIVISION OF CHILD CARE SERVICES. NOTICE TO EXPUNGE ASSOCIATED FINGERPRINT CARDS. This form should be completed immediately, when any person(s) who were fingerprinted.
[DOCX File]OMB No. 0925-0046, Biographical Sketch Format Page
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OMB No. 0925-0001 and 0925-0002 (Rev. 09/17 Approved Through 03/31/2020) BIOGRAPHICAL SKETCH. Provide the following information for the Senior/key personnel and other significant contributors.Follow this format for each person.
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