Open data baltimore city
[PDF File]Form SSA-89 (02-2018) Discontinue Previous Editions Page 1 ...
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I authorize the Social Security Administration to verify my name and SSN to the Company and/or the Company's Agent, if applicable, for the purpose I identified. The name and address of the Company's Agent is: I am the individual to whom the Social Security number was issued or …
[PDF File]Form W-9 (Rev. October 2018)
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City, state, and ZIP code. Requester’s name and address (optional) 7. List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN).
[PDF File]APPLICATION FOR ENROLLMENT IN MEDICARE PART B …
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APPLICATION FOR ENROLLMENT IN MEDICARE PART B (MEDICAL INSURANCE) ... search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the ... Baltimore, Maryland 21244-1850. CMS-40B (04/19) 2. Form Approved OMB No. 0938-1230 Expires: 02/20.
[PDF File]AUTHORIZATION, AGREEMENT B. Request Status …
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Electronic Requirements - An agency should only submit data for completed training that is defined as a training event for which the student has accomplished all components in the title of the event. 3. Collection of training data requires completed training events and that all mandatory data …
[PDF File]Declaration for Federal Employment* OMB No. 3206-0182
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minutes per response, including time for reviewing instructions, searching existing data sources, gathering the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of the ... (Include city and state or country) ...
[PDF File]Consent for Release of Information
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If you want us to release a minor child's medical records, do not use this form. Instead, contact your local Social Security office. I am the individual, to whom the requested information or record applies, or the parent or legal guardian of a minor, or the
[PDF File]CMS-L564 Request for Employment Information
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REQUEST FOR EMPLOYMENT INFORMATION WHAT IS THE PURPOSE OF THIS FORM? In order to apply for Medicare in a Special Enrollment ... collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the ... Baltimore, MD 21244-1850. INSTRUCTIONS: Form CMS-L564 (CMS-R-297) (0 ...
[DOC File]LEAVE REQUEST FORM/AUTHORIZATION - United States Navy
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navcompt form 3065 (3pt) (rev. 2-83) 1. date of request. 2. for . admin. use only. approval of this leave is . not valid . without control no,
[DOC File]Aid Codes Master Chart (aid codes) - Medi-Cal
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The Aid Codes Master Chart was developed for use in conjunction with the Medi-Cal Automated Eligibility Verification System (AEVS). Providers must submit …
[PDF File]Form 433-B (Rev. 2-2019)
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Complete all entry spaces with the current data available or "N/A" (not applicable). Failure to complete all entry spaces may result in rejection of your request or significant delay in account resolution. Include attachments if additional space is needed to respond completely to any question. Section 1: Business Information. 1a. Business Name . 1b
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