ࡱ> _ rbjbjzyzy k6b6b_7v v BBB$fffPdfYVD:~~~2&z&D&$XXXXXXX$[=^XuB(&&"((X~~3Y6---(~8~X-(X--Q*U~A͈)@|S&XiY<YSB_)_LUU_BU'Zn'@-'4''''XX{+8'''Y((((_'''''''''v B : Licensed or Certified Provider Agreement Form THIS FORM AND FORM W-9 MUST BE COMPLETED BY EACH CHILD CARE PROVIDER THAT RECEIVES PAYMENT UNDER THE CHILD CARE ASSISTANCE PROGRAM (CCAP). NOTE: IF CHILD CARE IS PROVIDED AT MORE THAN ONE (1) LOCATION, THE PROVIDER MUST COMPLETE A SEPARATE INFORMATION FORM, PROVIDERS STATEMENT OF RATES, AND FORM W-9 FOR EACH SITE. Licensed or Certified Provider Name: _______________________________________________________ (If you operate a licensed child care center or a certified family child care home, enter the name listed on your license or certificate to operate. The name recorded on the license or certificate must match the name used on tax returns or name as it appears on your social security card.) Indicate the Tax Status for Your Business:  FORMCHECKBOX A. Individual  FORMCHECKBOX B. Sole Proprietorship  FORMCHECKBOX C. Partnership  FORMCHECKBOX D. Limited Liability Company  FORMCHECKBOX E. Corporation  FORMCHECKBOX F. Public Service Corporation (PSC)  FORMCHECKBOX G. Government/Non-Profit If your tax status is: Individual - Enter your SSN as shown on your Social Security card. Sole Proprietorship - Enter your SSN or FEIN, followed by your name and doing business as (DBA). After DBA, enter your business name. Partnership - Enter your FEIN or the SSN for you or one of your partners. If a SSN is entered, also enter the name of the owner of the SSN as shown on the Social Security card. Limited Liability Company - Enter your FEIN Corporation, Public Service Corporation, Government/Non-Profit - Enter your FEIN. (FEIN) or (SSN): __________________________________ (Enter the Federal Employer Identification Number (FEIN) or Social Security Number (SSN) you use on tax returns) All providers are responsible for obtaining correct taxpayer identification numbers (TIN) for the W-9. For individuals, this is your SSN. Providers are further responsible for properly maintaining records in case of an IRS inquiry and for the purpose of assuring correct 1099 reporting. License or Certification Number ___________ Expiration Date__________ Phone No. (____)___________ Location Address_____________________________________ City/Town ______________ Zip __________ County _________________________________________________ State ______________________ Mailing Address __________________________________________________________________________ Director/Owner ___________________________________________________________________________ Licensee or Certified Providers Maiden Name __________________________________________________ Licensee or Certified Providers Date of Birth ___________________ Rate Charged for Child Care: (Birth 12 mos) (1 2nd Birthday) (2 - 3rd Birthday) TYPE OF CARE: INFANT TODDLER TODDLER Full Day (FD) $  FORMTEXT       per day $  FORMTEXT       per day $  FORMTEXT       per day Five (5) or more hrs/day Part Day (PD)  $  FORMTEXT       per day $  FORMTEXT       per day $  FORMTEXT       per day Less than five (5) hrs/day (3  4th Birthday) (4  5th Birthday) (5  6th Birthday) TYPE OF CARE: PRESCHOOL PRESCHOOL PRESCHOOL Full Day (FD)  $  FORMTEXT       per day $  FORMTEXT       per day $  FORMTEXT       per day Five (5) or more hrs/day Part Day (PD)  $  FORMTEXT       per day $  FORMTEXT       per day $  FORMTEXT       per day Less than five (5) hrs/day (6  8th Birthday) (8  13th Birthday) (13  19th Birthday) TYPE OF CARE: SCHOOL AGE SCHOOL AGE SCHOOL AGE Full Day (FD)  $  FORMTEXT       per day $  FORMTEXT       per day $  FORMTEXT       per day Five (5) or more hrs/day Part Day (PD)  $  FORMTEXT       per day $  FORMTEXT       per day $  FORMTEXT       per day Less than five (5) hrs/day Date Rates Listed Above Became Effective: ______/______/______(Month / Day / Year) Special Needs children served:  FORMCHECKBOX Yes  FORMCHECKBOX No Is this site accredited?  FORMCHECKBOX Yes  FORMCHECKBOX No If yes, name of accrediting organization_______________________________ Do you charge an enrollment fee?  FORMCHECKBOX Yes  FORMCHECKBOX  No If yes, how often is the fee charged?  FORMCHECKBOX  Annually  FORMCHECKBOX  One Time  FORMCHECKBOX  Summer Session What is the amount of the enrollment fee? $_____________ Is fee:  FORMCHECKBOX  Per Family  FORMCHECKBOX  Per Child Please list hours of operation: Monday through Friday Open:_____am/pm Close_____am/pm Saturday Open:_____am/pm Close_____am/pm Sunday Open:_____am/pm Close_____am/pm Check Applicable Provider Type:  FORMCHECKBOX Center (Licensed Type I)  FORMCHECKBOX  Group Home (Licensed Type II)  FORMCHECKBOX  Certified Family Child Care Home Provider Rights and Responsibilities To receive payment under CCAP, I understand and agree that I shall: Meet all regulatory and statutory requirements related to my child care provider type (Licensed or Certified) as listed below, which can be found at  HYPERLINK "http://lrc.ky.gov/kar/title922.htm" http://lrc.ky.gov/kar/title922.htm: 922 KAR 2: 020 Child care assistance program (CCAP) improper payments, claims, and penalties 922 KAR 2: 090 Child care center licensure 922 KAR 2: 100 Certification of family child care homes 922 KAR 2: 110 Child-care center provider requirements 922 KAR 2: 120 Child-care center health and safety standards 922 KAR 2: 160 Child Care Assistance Program Give permission to the cabinet or the CCAP staff to verify any information necessary. Maintain capacity to no more than the number approved by Fire Marshal, which includes both children and adults, at any given moment of the day. Maintain information and records concerning children and families in a confidential manner, including information and records of children who do not receive CCAP benefits. Not use any form of abusive language and/or corporal physical discipline, including spanking, shaking, hitting or paddling. Report to the CCAP staff the opening of a new site, an address change, a change of ownership, a negative action, or a change in provider type (licensure, certification, or registration) within five (5) days of the change. Charge the parents of children receiving CCAP benefits no more than the rate charged to parents of children who do not receive CCAP benefits. Notify the CCAP staff and the parents of children receiving CCAP benefits of any rate changes ten (10) days in advance of making the change. Not charge the parents of children receiving CCAP benefits for any days the facility is closed if the provider does not bill parents of children who do not receive CCAP benefits. Collect daily family co-payment fees regularly. If the co-payment is not paid on time, I will contact the client to set up a payment plan to get the co-pay current. Not permit an employee receiving CCAP benefits to provide direct care for the employees own child. CCAP BILLING AND PAYMENT Sign and return the DCC-94, Child Care Service Agreement and Certificate, within ten (10) days of it being issued. Payment will not be made until the signed Service Agreement has been received. Complete a Form W-9, Request for Taxpayer Identification Number and Certification, and submit it to the CCAP staff. I understand that I am not an employee or contractor of the Cabinet for Health and Family Services or the CCAP agency.I may be subject to federal, state, and local taxes and other requirements. If I provide services in the childs home, federal law (the Fair Labor Standards Act (FLSA) (29 U.S.C. Section 206(a)) considers me to be a domestic service worker employed by the parent and therefore covered under minimum wage laws. If I have questions regarding my status or the tax implication of any payments made to me on behalf of a parent by the cabinet, I should contact a tax professional, the Kentucky State Revenue Cabinet, or the Internal Revenue Service. Be reimbursed by the Cabinet for State or Federal holidays for which the provider is closed only if the provider bills parents of children who do not receive CCAP benefits. Payment under CCAP will not be made to a licensed or certified provider for more than ten holidays per calendar year. Not give any part of the CCAP payment to any employee of the cabinet or the CCAP staff as wages, compensation, or gifts in exchange for acting as an officer, agency, employee, sub-contractor, or consultant to me. Not receive payment from CCAP for any child that I care for who resides in the same home as I do. Understand that if I operate a child care business in my home, my child(ren) is not eligible for CCAP benefits during the time I care for (an)other child(ren). Promptly pay back any child care payment received to which I was not entitled to receive. Ensure that CCAP payments are made only to the center approved for care. When a center is closed, the center cannot move children to another center and expect payment. Maintain payment records for a period of five (5) years. This includes the DCC-94E, Child Care Daily Attendance Record. Not be paid for payment requests or adjustment requests ninety (90) or more days after the service month. Not give false information or withhold information as I may be subject to CCAP disqualification or prosecution for fraud. Be required to pay back any overpayment and the overpayment may be pursued as an intentional program violation in accordance with 922 KAR 2:020 if I or staff acting on the child-care center or homes behalf does not bill accurately in accordance with 922 KAR 2:160. Be reviewed after a monthly DCC-97, Provider Billing Form, has been processed and paid. CCAP staff has the right to review and verify the accuracy of the form and the payment. CCAP payment(s) shall be adjusted if an overpayment or an underpayment has been identified. I will pay back any money I receive in error, even if the mistake is not my fault. DCC-94E, CHILD CARE DAILY ATTENDANCE RECORD Maintain the DCC-94E, Child Care Daily Attendance Record, in which the daily arrival and departure times of each child is recorded. The childs name must be legible and must be written the same as it is given on the DCC-97, Provider Billing Form. Sign the DCC-94E, or an employee acting on my behalf shall sign the DCC-94E, at the end of each week. I shall ensure that client or designated person does not sign the DCC-94E prior to the end of care for a given week. Not receive a payment for days or weeks during which a child(ren) is not signed in or out on the DCC-94E. If I or a person acting on my center or homes behalf fails to secure the appropriate initials daily and the clients signature weekly, any payments received will be recouped. Not be paid for any absences or holidays for a child who does not have attendance during a calendar month. Submit the DCC-94E sheets upon request of the Cabinet or designee. Complete the monthly DCC-97, Provider Billing Form, accurately, promptly, and according to instructions. Complete the DCC-97, Provider Billing Form, as documented on the DCC-94E, Child Care Daily Attendance Record. Complete the cabinet approved training on billing and the DCC-94E. Reasons CCAP payments could stop: I understand that CCAP payments may be withheld or terminated: Upon thirty (30) days notice due to a shortage or unavailability of funding; Upon ten (10) days notice due to failure by the provider to comply with the terms of this agreement or by violating 922 KAR 2:020, 2:090, 2:100, 2:110, 2:120, 2:160, 2:180, or 2:190; Upon notice of the Office of the Inspector General, Division of Regulated Child Care, that failure to comply with provisions of applicable administrative regulations has caused my license or certification to be suspended or revoked; When not in good standing with the Cabinet; or While a disqualification is imposed due to fraud in accordance with 922 KAR 2:020. Child care arrangements and all CCAP payments may be terminated immediately if the cabinet initiates a Child Protective Services investigation involving me or a member of my family, and the cabinet determines that I have not satisfied the cabinets safety concerns by preventing further contact between the subject of the investigation and child(ren) served by me. I understand and agree to all of the requirements included in this Provider Agreement form. I also understand and agree that I will follow all of the requirements of 922 KAR 2:160. _______________________________________________________DATE________________________ Licensee or Certified Provider SIGNATURE Licensee, as defined by 922 KAR 2:090, is an owner and operator of a child care center to include sole proprietor, corporation, Limited Liability Company, partnership, association or organization. PRINT NAME AND TITLE:______________________________________________________________ In order to receive payment under the CCAP, you must complete, sign, and return this form and Form W-9 to the address below. These forms must be updated annually and if any changes occur, they are to be resubmitted to the CCAP Staff. Keep a copy for your files. CCAP Staff: ____________________________________ Address: _______________________________________Phone: (____)__________ FAX: (___)_____________     DCC 94B Commonwealth of Kentucky R (R. 11/09) Cabinet for Health and Family Services 922 KAR 2:160 Department for Community Based Services Division of Child Care Cabinet for Health and Family Services An Equal Opportunity Employer M/F/D Web site:  HYPERLINK "http://chfs.ky.gov/" http://chfs.ky.gov/ Page 1 of 4  DCC-94B Commonwealth of Kentucky R (R. 04/17) Cabinet for Health and Family Services 922 KAR 2:160 Department for Community Based Services (/0:>CFG / q r  . ƹ~m_jhbCJOJQJU hb5CJOJQJ\^JaJhbCJOJQJhb5CJOJQJhbOJQJhlhb5CJOJQJhlhb5>*CJOJQJhb5>*CJOJQJhbCJOJQJhP<h%%5OJQJ\^JhP<hb5OJQJ\^JhdMhb5OJQJ\^J!/0q r  S T k l dhgdbdhgdbgdb&$d%d&d'dNOPQgdbgdb$a$gdb. / 0 I J X Y Z e u v w ӿӵӡӵo['jh6ShbCJOJQJU'j\h ^)h=zCJOJQJUh ^)h=zCJOJQJ!jh ^)h=zCJOJQJU'jh6ShbCJOJQJUh=zCJOJQJ'jth6ShbCJOJQJUhbCJOJQJjhbCJOJQJU'jh6ShbCJOJQJU ( ) 7 8 9 S T k l y ; F I N W g k ӿӮykky\y\Kkkk hNhbCJOJQJ^JaJhb5CJOJQJ^JaJhbCJOJQJ^JaJ#hhb5CJOJQJ^JaJ#hhb5CJOJQJ^JaJ hhbCJOJQJ^JaJ hhbCJOJQJ^JaJ'jh6ShbCJOJQJUhbCJOJQJjhbCJOJQJU'jDh6ShbCJOJQJUl ; lm=5dhgdbQ & F H$!Eƀ)Rgdb & F H$!gdb & F H$!gdbQ & F H$!Eƀ)Rgdb  X[lm<ϯn\nJn9 h'zxhbCJOJQJ^JaJ#h'zxhb>*CJOJQJ^JaJ#h'zxhb5CJOJQJ^JaJ h'zxhbCJOJQJ^JaJhhbCJOJQJaJhb5CJOJQJ^JaJ#hhb5CJOJQJ^JaJ h ^)h=zCJOJQJ^JaJhxq5CJOJQJ^JaJ#h ^)h=z5CJOJQJ^JaJhbCJOJQJ^JaJ hhbCJOJQJ^JaJm<=^_&<_&  ^gdb^gdb`gdb d^gdbgdbdhgdbdhgdbh^hgdbgdb<=^_ƼӮƠ{rf]f]ODhb5;OJQJhn]hb5;OJQJhb5OJQJhdMhb5OJQJhbCJ\aJh<NhbCJaJh<NhbCJ\aJh(@hb>*CJOJQJhBehb>*OJQJ^JhbCJOJQJ^JaJhbOJQJ^JhBehbOJQJ^J h:6hbCJOJQJ^JaJhbOJQJhbCJOJQJhbCJOJQJ.0RT_  XZnpr|޾ޠޓ~n\~L\jhGkhb>*U#jhGkhb>*UmHnHuj,hGkhb>*UhGkhb>*jhGkhb>*UhGkhbCJOJQJhGkhb>*CJOJQJaJhGkhb>*CJOJQJhGkhb5>*CJOJQJhGkhb5CJH*OJQJhGkhb5CJOJQJhbCJ OJQJhbCJOJQJ|~$&(Fdfz|~.0DFHRTf析ހp`jzhGkhb>*UjhGkhb>*UjhGkhb>*UhGkhb5CJOJQJhbhb6CJOJQJaJhGkhb6CJOJQJ#jhGkhb>*UmHnHujhGkhb>*UhGkhb>*hGkhbCJOJQJjhGkhb>*U%&(fhTV<F<np`gdb 8^`8gdb  gdb`gdbgdb^gdbhRTVtƶƦƈ{sc{Q{{sA{QjfhGkhb>*U#jhGkhb>*UmHnHujhGkhb>*UhGkhb>*jhGkhb>*UhGkhb>*CJOJQJaJhGkhb>*CJOJQJhGkhb5>*CJOJQJhGkhb5CJH*OJQJhGkhb5CJOJQJhGkhbCJOJQJhbhb6CJ OJQJaJ hGkhb6CJOJQJ\^rtv(*jl"&析ހp`j>hGkhb>*UjhGkhb>*UjRhGkhb>*UhGkhb5CJOJQJhGkhb6CJOJQJaJhGkhb6CJOJQJ#jhGkhb>*UmHnHujhGkhb>*UhGkhb>*hGkhbCJOJQJjhGkhb>*U%&<BDFVdh`:<PRT^ƻֻ֛֫֫֍}phXpF#jhGkhb>*UmHnHujhGkhb>*UhGkhb>*jhGkhb>*UhGkhb>*CJOJQJaJhGkhb>*CJOJQJhGkhb5>*CJOJQJhGkhb5CJH*OJQJhb5CJOJQJhGkhb5CJOJQJaJhGkhb5CJOJQJhGkhbCJOJQJhGkhb6CJOJQJ^`(*<lnp(*,68vxެ掀p`j hGkhb>*Uj hGkhb>*UhGkhb5CJOJQJhGkhb6CJOJQJaJhGkhb6CJOJQJj hGkhb>*U#jhGkhb>*UmHnHuj* hGkhb>*UhGkhb>*hGkhbCJOJQJjhGkhb>*U%E F g h v w x ~  ĶĶnZO=#hGkhb5CJOJQJ^JaJhGkhbCJaJ&j hGkhb6CJUaJ&jx hGkhb6CJUaJ jhGkhb6CJUaJhGkhb6CJaJhGkhb5CJaJhGkhbCJaJhGkhb6CJOJQJhGkhbCJOJQJ#jhGkhb>*UmHnHujhGkhb>*Uj hGkhb>*UF ,!-!z!!7"|"}"" #<#=#_#### d^gd|3dgdb^gd|3`gd|3`gd|3 ^`gd|3^gdbgdb  ^gdb ,!-!N!O!]!^!_!e!f!t!u!v!!!!!!׽ףבw]C2j<hGkhb5CJOJQJU^JaJ2j hGkhb5CJOJQJU^JaJ2jP hGkhb5CJOJQJU^JaJ#hGkhb5CJOJQJ^JaJ2j hGkhb5CJOJQJU^JaJ2jd hGkhb5CJOJQJU^JaJ#hGkhb5CJOJQJ^JaJ,jhGkhb5CJOJQJU^JaJ!!!!!!!!!!!@"A"O"P"Q"`"a"o"p"q"|"}"""""##ncUJUJUJh|35CJOJQJhGkhb5CJOJQJhGkhbCJaJ2jhGkhb5CJOJQJU^JaJ2jhGkhb5CJOJQJU^JaJ2j(hGkhb5CJOJQJU^JaJ2jhGkhb5CJOJQJU^JaJ,jhGkhb5CJOJQJU^JaJ#hGkhb5CJOJQJ^JaJ#<#=#\#_#`#n#o#p################ԯԛԇvdUFhXo5CJOJQJ^JaJh5CJOJQJ^JaJ#hA]hb5CJOJQJ^JaJ hGkhbCJOJQJ^JaJ'jvhGkhbCJOJQJU'jhGkhbCJOJQJU'jhGkhbCJOJQJU!jhGkhbCJOJQJUhGkhbCJOJQJhA]hb5CJOJQJaJhGkhb5CJOJQJ####$_$K%%%&F&&&''F(()/**r+,,, 0]^0gdG9Zgdo  & F dgdo d^gdo d^gd|3#$$7$8$]$^$_$$$%%&%H%I%J%K%&&((/*9*,ɺɨss_sM???h@CJOJQJ^JaJ#hoho5CJ OJQJ^JaJ 'hoho0J>*CJOJQJ^JaJ)jhohoCJOJQJU^JaJ hohoCJOJQJ^JaJho5CJ OJQJ^JaJ #h mhb5CJOJQJ^JaJho5CJOJQJ^JaJ#h mhb5CJOJQJ^JaJ#hP:hb5CJOJQJ^JaJ#hP:hb5CJOJQJ^JaJ,,,--.:.11 333333P3T3_3`3c3d3f3p366 7 74858a899A999<<<<<ʼʼʮʠʠʠʠʠʠʒʄʄsʄʄʄʄ hP<hoCJOJQJ^JaJh_"CJOJQJ^JaJh "CJOJQJ^JaJhoCJOJQJ^JaJh@CJOJQJ^JaJh :CJOJQJ^JaJ hohoCJOJQJ^JaJ#hP<ho5CJOJQJ^JaJ#hoh5CJOJQJ^JaJ&,,]-j01d22f33k44N5564858a8Z95:R;;<l<<==gdA] & F gdo  & F dgdo0^0gdo<<==?==/>>>??_A`AAAAAͻ滋ziXF4F4#hP<h045CJOJQJ^JaJ#hP<hZ5CJOJQJ^JaJ h mhZCJOJQJ^JaJ hohoCJOJQJ^JaJhoCJOJQJ^JaJ hohoCJOJQJ^JaJ htihtiCJOJQJ^JaJ htihoCJOJQJ^JaJ#htiho5CJOJQJ^JaJ htihA]CJ OJQJ^JaJ htihtiCJOJQJ^JaJ htihoCJOJQJ^JaJ=@===>m????_A`ABBkBB]C^CC `gdZ ^gdPj gdZ$ ^a$gdZ0^0gdo0`0gdo  & F dgdo & Fgdo`gdoAABBBIBMBNBRBjBkBsBtBvBwBBBB̻ucQ?-u#hhPj5CJOJQJ^JaJ#hh4\5CJOJQJ^JaJ#hh4\5CJOJQJ^JaJ#h mh4\5CJOJQJ^JaJ#h mhPj5CJOJQJ^JaJ#h mhZ5CJOJQJ^JaJ h mhPjCJOJQJ^JaJ h mhZCJOJQJ^JaJ hP<hZCJOJQJ^JaJ#hP<hZ5CJOJQJ^JaJhF5CJOJQJ^JaJ#hP<h5CJOJQJ^JaJBBBBB\C]C^CrCsCCCCCCpDuDyDDDDͻweVeVeVeD#h mhRD5CJOJQJ^JaJho5CJOJQJ^JaJ#h mhZ5CJOJQJ^JaJh m5CJOJQJ^JaJ h mhZCJOJQJ^JaJ#h mhPj5CJOJQJ^JaJ#h mhZ5CJOJQJ^JaJ#hP<hPj5CJOJQJ^JaJ h mhPjCJOJQJ^JaJhoCJOJQJ\^JaJ#h mhPjCJOJQJ\^JaJCCDDDDDDDD_EaEbEdEeEgEhEjEkElEmEEF\Fgdbgd~,^gdRD ^gdRD ^gdZDDDDDDDDDD$E(E^E_E`EbEcEeEfEhEiEkElEmEvEzEϢ~ld`d`d`d`\XMAhRRhA]CJ\aJhA]5CJ\aJh54hhd'jhd'U#h mh4\5CJOJQJ^JaJ#h mhRD5CJOJQJ^JaJ#hP<hP<5CJOJQJ^JaJhP<5CJOJQJ^JaJh&o5CJOJQJ^JaJh|a5CJOJQJ^JaJ#h mhZ5CJOJQJ^JaJh 5CJOJQJ^JaJhF5CJOJQJ^JaJzEEEEEEEEEEEEEEEEEEEEFFF F F FF4F[F\FFFFFFFFFpG͸ĸĸĸĸĸĸ٪ē}yf%hNhA]B*CJOJQJaJphh54hhA]hRRhA];CJ\aJh #+hA]CJ\aJhA];CJ\aJhfhA];CJ\aJhRRhA]CJ\aJhA]CJ\aJhGkhA]CJ\aJhRRhA]CJaJhA]5;CJ\aJhRRhA]5;CJ\aJ&\FFFFFpGrGVHXH\H]HHQIIopq gd|3 Z^`Zgd|3 ]^gd|3 $^a$gd|3gdb$a$gdb Q'p&]^gdbgdb gdbpGrG{G|G}GGGGGGJHTHUHVHWH[H\H]HHHHHIII׻䫠|papVJ>JhXDhCJ\aJhf{hA]CJ\aJhRRhA]CJaJhRRhA]5;CJ\aJhA]5;CJ\aJhA]h)hA]CJaJhA]CJaJjh.hA]CJUh8LCH2/{^WF<{CJo$ngE*c q1FbZ+<+*ol׾Ol&eq,.Hgc~M%0OSg|EY}y]BqZW_kwRss75B pEB"y lk<>p(m=[fqI%2SR̻-zc^&:Cu-i%LGAk/9s~"'$x\Kyy!Ox^Oy^)BzkyD]{L}>,dZ6_Q 9~`]VJԆFX'lK!;ᷕn#ܖez~Aj?/߾EET>C#oTʎbR)=2۩!xbl:ޠ9m^-}1nq纗yLC&k'%Y^Bc?fq_!3-llom@ R(>C.g}Nj_`UhsǑ`ߡv۴W(?rc8/W^In?93~I6|>~ 3[y|쓜~B|趽Ǻۻvm-wVڧ6jktwT3ZM_45tNQs;GwN.tYE:+Xk,VĪF0O5e)SajUK8k鯸6,n]ֆn-քF| ii]ڍE5nn5Vnyk rKWnQ(naH T5-ݼJ_@M7;`i?y)n!X薆xn[pm .Yr[au+fw[s;0͠v?5簋(/v *y ;z "ƶM_R( 9)ݡp nnmzp<x?n LvH=>nGރm!m ~d9 vT=xGk|}XI7Trp?trC43N4h5p'Q\w$ g^5 y{5Wyxs/Ǵziϊ'P ʯad5.Yd!h)A/! \Ϝ+NI8锃NԆNcX9ϩgp۩ /p۟ȯ , %Y YѲ]&&6{➇s5>Ip} \xͬ%_7>w?J~^Yâ^y,9 xe^1'`M^ÐF-5ἶy{q7{|z1AxY;G8Nn2kzX>3 |u±^EӼhm6gwhxMfx#7'jWnʼ7yK{:p^vin?Xb3w9twjRlN0wn/\/p[7p[I10 pypߗn\fn:\*\on ,sJ7ܫvv= gܳvG/?nׁhr'^ꦶM݁?T2WwvvQ־e#U"!oQ: qBw'Tvl] ?af xyW.$N#wj~BCz~z(ong6Ѯsg96@w6|Bq~fwHd]j \US_IKM֪qD0Z j4{ -P&#Sà_Kn 5 ErqeOHm7rwhf@K5 ڨ?B/UBCMPImR}nJ{r9\ 4m͕C7[v62PV|5dd:;]`:}ߝ;g$pBkg4p&CEg*v~ه4H88i= sy{2̀p r8*;k1~ 8 t8Lǐ^0VKӚ MN #<&BʃpS^Jt5 *+tZ8H}UfmʤUnor1ZL.Arw[ e*l6,쬂VQ/ V3>5頋`@2&B漿y|Vywa<^mVO"VߡG5An ﵉l.H߸+`Z>xVL9nx*>7+sz₁m CHL(+fC1r\//r("VA F. ʉ=P^dGr<7 n'YA 5[0F]>#8B0 N*| ˂ɰ>xY;do:/I8<׵FTj>RAAaA?ϵYx5 ;А:@4 Ł14'0fo?hb`6M ,i偿:XL n`>= ̡\ N'/8> JGRP 6T7xCqzm,` Ӧ`'mo{:DKf0RJp/"[tתL)fvR~ßUwZǪUUTEq*TA°*xU4e0*᧪fec_ZyT=-jU3xS ,j <>|wtS~Ae&+h7dmJtW'=$SEQ:Ճrª;Qݨ#5QmjN]U}xU6_MRhGCOΓWQs[E%>*};8 z.OR(ONymay.,GF9/i1NCk;_`q3{rz.7 qcg"M~k3ps\~:qw9é[ )+)k;yqGᯝ0aNYWUN|;.]=#1 K0މs~8ϖ4Y| )\le|RVٵh݀6'ݎ۝݅nQIȧvzGN-Ӌ*;ݩI=4&;ui! N:s ")f\B'qQ#&4c}@EXFٍpom쏳`"1r,؎ i(`]XRrVTagUy{TOZWي4XvѲ;MhM[Qcge':ԐC5-hleidUZ!fI8A_=^g ߫M;ws𘜊y͒x|"w}lk/d-L,ɲ8ސ q̧maq_9,ce).@Yp!6GNrˉW_#;y翛Ǘu{ v_m:h! /gMHړ]r^zJG E3_K_GNB 1SP|(~d1o)xIi1'6lS[ Vr['F "hgEs""0}]DcG1[r1 k%[b'簨c,(^cP˦<;(eP*-PyшT[F5^DQIDo"Q/Mߢ]2)#I%e6Q!:U1JS#E(Ɛ4xu\n,-!(^(|]Li!;ղ?qόkxwgtI׍0VFUJ4j>5є5:2QFߌf Ubu>TT2#ٞʘ-WJY*3 7ܨ1cq98?mqTf8,̒,̂,uZeV 00̲(͊ƨsNjF'|">Sc1~aT,f2OX״ZWuMDshTŲŌ\~ȏʗ" Y.g8_|Q sh<=1? _iCC}PUNЄs #&x\ E~*"A/RD^Т|? زH?q( 6V-堙x'p lP^ٍ6{XY][hְr/?џ-thIFGρ산|PoQƾE+ǻ/{Y#v$-u㷣yg|~-:GKKx}WGSIpt D'8gDGM3 l/sEс|Ot0/A^m 'q]߫Zk}?o@Ms}hva[Aˣy>h&;7G@7ٽ!]N_ye3^k/7<7廆uE.v*_oy}l-bñ|hnl ώ-YyFN)M ync3ͼ v Kbm$+{UlŻ֣wSJP?3' A;=x\hIN 2\ rFuY8ig-? 1P!ˍZ*T #!2^"w,s\gcx{)O~# |;B}%@^9(),!fO恦A~~,uԀ<7[[2 mh;຀(l.T6tb}} cF>QDiZTbԘaS'^İQ=:a֍ ދ`B/wL5FReuj'5{1fRmrCkF'ѣM4*,[lUHF8V)u b\!5m.Qm9zWP3[I.$WlT HVDL)lBilT%*y4Ke-ˈH:Q/kT {ޫWQIt ~yIj*/ ch٦lэJXS+/:⬥JАYQFeeT@RK@*iP@Q6^aʈ:*h }*D;"۟r-'|U",9 СUE`#tB狚?)9aV'>DFYGXW}2YPLqZpOBܓ)}3I2){Y_}2Faâ)Z<܄X+%YV3|SF?\]N\us&"ڷ+hf,kUt!tlk5 EWjJS02ױ"+PIYʈd3ؑe]J͋[]E|yg l>M~0чYI1Z-))#q\g OQy T>'IȿedI9_  5ztg'~48~Ec+oӃI}+~w ey5ŵ4_ԣpt-O{ P\"wTx4N_ :}&]OQ:Chz:_k:KN?]: &RGTR/)NІVtnK]MOu}H*)3(樂^LW)_p=VBG-Av):X?@m\jgtAi=ZTA/PމgP+7jmHǚ1IsazR7ӝr$:d92OqRTgVƧN/ .f$fꨗD皫s՘;hy 9q>Y2NU RDU? ֜ԻwheJk+زk򗖂 ,sy13$#UbIZɈ[3fSN)k+_ > cUlƎs'``**d[>'}_Tڲ# e\1KJ E/'] 4<'y6n1a/D.H2 $xŒttJ^> ץM3"r(~EGP}Z]A-ܥ(;t:;v\:F̈́ bmR\A4Y`.f -1!3sq3縈C=rc4 4,e]oLwۑ%$"Id_$, %(adMDddGH=* " ,r?z>R===3UJB#4B{#/ΒJLg~" 㨿E|z+՜bvRwzUYLCln^Qf:3ShyV™4,f90n4Z}f=m>f?M1hϖf7-2of+-1 K|䍥f1LӉ4d}C4Tvu穭>JLozݧ F5nFu])@9:kM4P}NC^zRI#Z^LQj PiJTUJ0C|zJVs7PiK \N?Y)ڥ12 h?u+Ofߣ0d>|LM}i)3~~dUnp'i(se !ⷡ.tG#?NCߓ~ҏt( `~[:c>:vq>7!3>0;f$aRyDO-3iOI~F36eE"caR_JMuZR}1{Wuy]DCK'Wici_fHY~NOiPJQ%qrc|ߏh"Eh4NqN&E,gb>"%U)(i`b9}W+,废,`TD.Rf<cԡ3HCQ>B4BUZFk4S*>zVʓ/ަzV:DU:K͗;i47VK9B܂jp.qo*(-<|@/(A1x5)t??Kyur}~hܙ4+|L[z oJFG k"r\qw$pќ!AWވ>N0Eއ% C>:o o%~y 5\.>wy*qCUBi,iT @oF)$c2bާ_qX7t ]]Lc O͗yIOeOzi㪼_~;~P۹]hJncA87nus+c׮_l8JQUuNT.Ln nFq;6&sgׁ;9Yn.ps^ʷt76#[vn6.p>*)x]&;]AQ=8;t]G-:}n}u7wsy5?>s*jk&ac%Ę (g"ʜB9Sh&7O LLLALGyEe栞&fIy̳ocOM76Ҷ\dqMkN2mi LGnjYf3 fq[1˅ȼ}\|ʵ\\"-ɯ•Ҝ&> ?joϘ<9=~lg+Z^kp4b&V3 ]-f {oǦ.baß^| 9I/ |P^s1xF#y_lOx7G,nq51ya8f6 9 _* *H<߇r0Bd2 |OE?p[)uqetDy5xHB$?#E2WD.E pbv{qZ5w3s 8Z|:7uVnn1;En{[zp3/nL28k5\[.x7 7\$,&$N&s7fp}o7=qo g{oppTU5'}XI bmU Rx.KߞA98*xBe#4v!o3zKԛw8=s^..{Y )^=e9ʫ$a'Ky\++^NyW L꣛mvA ռt1^iS i[#icf!l|QdczlȞqȇKZ)U+^Tqڢ6=끴[D< ].ˎ.?9B]u+\Uj\CUfrzxFqzK!\B f_ dG Q5aآFb$RϣUDmD=w=HS#U}&8*8.Pߢ:{WgXCK K!-e:'6H]A_.tyUZǣ t-ՉHԒxJ*btD"(Q#t5 UOiw6rUkPO0U՝X`S4.R.˨R\Rr WQR9]ݪ:7PDep U[r{wP9[ r[[]X}#8Zu8; 6ɘWa^=<!W@>2ȚE%]MM47eDB;A2ã@}cI~+z=VXb~b-8(8)W*i_>W8Au~n?f8gl%!{4gp}wDNzMs7幈+i^};?U_G`WR1Oc aɔ6ȓ5ɓ5ozZSa*Y[Ⱥrm"!ʒ%(o,B\<\6R/,8LjY͙a;.in8'#q'\NrG87܀pm̵x!W\ߖRp1"`S9!Nd9Cq3qNshLA3 vg"9` G\\t:dq G:sEAkJ^iiBtLAntΣӜ̕wV8sS$Y\y՝e|F+zJ;cc圖86Ώh\@f!?HUuCIsQ·(B\C*nu#ƙqhTsuZ8@vtu'^' w9H:)P^ʔsK=qrRWċ A섪 j.n$'?D|Xx34-%=۱QvUx^b4Oh\{ruኚܚ9]PCPE$W'Q78J[eUWY웮N wǮp\۸ԛ);SbDmMH+Һ/ס8)݂^++墥|OC EYx WŝҪ HqCp?_49xXuQ&jXyL -l<QzjciV]?+˿?*.SxX^29ҿB~GӬ'@ϧvsLLJ Y[Y0]'7r49&%h$5mP,vJD FEѐU#.JIRv17AX=Mh9شvV/DdTF(@f^]#wE>Rg;P)ˢ΢Yt =CmyR_a_ nX lGxRRmspI 7!o::aBV;ؤg HK gEkZm\f$Û9_*JIi=ˮ7 ?Q:\LRbB]ij ogyUjՖ(AVWr5hy76 MIv v8%j_Z}ghbrXzeXW5aՏ_X[=%j#tF"bMy,f3ڤBER(}a_074gYO*f]l  =p2JXԺK %`bdDZi|1oI7#ܮ9{rNȦ?(S,4ÅKX֋Fs:K$37e[jή7uӮsn}a},YO9 k} AklЌD :}0X{۲LWl-IxoY֡Pp?[Yi$pDb]Zΰ~+MRW@93- xA|Z̀~ i7%wdaQ}mn!eotήnPƤOH|o/Q6DyK http://chfs.ky.gov/yK (http://chfs.ky.gov/Dd d0  # A2Z21$|f' Wn`!Z21$|f'h*-|0x U؆!Z"ZlQBDcgR$e-K],!ɖ}'$i?齾ޏ7s>3$M$?è ^AQYrJ^z}W-ҩmNʗA#Rރtɏ-_#T~Hǐ#LK=_I$}הP2/]}Iit "p_H_Gx;~Azx`%䯫?[ȳT+$F4c$;O%CFzzO5R!3JArAVU(ʢLʨS\0H[z"B*J! ;RJy~G)CʪiU,GT6UJT%ʃO|l %QP%ʩQЄ|W MH{; :VQoHx_ A*JdDzg@؏P}?ʯ ԕHBBCO$UkuG/譢<}azD|I (ߣa0q0_ }a\|q, nK2zt9vS3l;eɱ8-&N g>:BFx1̥i8c<a{ )0[k,u.m7/I;p1s1srrxNn0F¤0>R^c&9K< "q9x6F!W@^dueSr F:c"~>ܠ:Ve=_My C.tںQLTFV9=%R:)dVcd#Zcц]~DuԥTg]Bun.z*A{\;hހwǥȫ:ƛ߯m(ɋOOʇB;W!a&;z9eq򎰽0mxvi"L i (GрW5QLUTLD^ɀnzlDGbqr&&?L6C3ˡPWHG^;S?y:괡.<ϳKM1m^Fm@ga`PƝI-;I'il^e<*d9RP.?\/E2Ѷ'/!79!9+dszp6r^J΀6֓R2/SZr릨\6) gL^9ar1M,rDAsĤMF9n2Ih`rP6'6rM[ Q6'6M%Ԃyn@6z;QwW|nJ-#=mlț֦Via4!WxnG[́M0e"2і鶴̣//lYYkal"ͱmYm+g,e!̃Yl5>.yJ6 xNdm*;msξ$׾&mQQڷMs[vP@ܶ`8vbߓv\P.ڱK]B*sCg~gW5l)+o!~δ/dgm sm=|,} uyB:Y|lGj41B|ҍxwv-F_8Ӗt2y') }Ɣ{~Gձ:T?c8mg<9//P bN~7YKM;t#O)O] i )WOeڅx n6ѝ s%/޾N4sEبHOz"C֌XCű[l3=\9ӂ}\sg^A˦{[SFz3bÑ>T` mc z֐fVķQ-:=aQ1ں A\[[!)_$F1a ᾩ ;ۥٿKחd/!88.޿&}+:_XYoϱخ6eayh*ҷ@~ HM 6`jD"qcj4ueyB}9 Mt'S~<`p ^ܝsL'1m8ǼlV哆$ԂPHI ݜ',rrS儮$`v6V应gkH[GMlUe.uMٯkap nß11D&G^U*Yxgk_܅˾#ؼg7-eiMO <ߙys[gxwOI"{YX3sض^BǎܜXO#w۴N5meyk-_W=ch%sfiL='sMF:fdyg[ ? ,sYdCΒp6繍n c cy6@*ϊPs30wyoJ|['grߑIUY!3OMkyV!WVjzOz'x_F7C%Y%buY"o|(LD%d 2JMI-]$^Io$=#>,O夁JC)-IIy^JP1i"EX^$޶T+o#OW]_UVfHa[Nxr%_$+_^!*|:He"%s("T I{q9t+Pe!IFOSلe"Q( =HKi,A\GJV5QKMjW^o+՛bg8s#ɧI=6wIDYm͒VmMߌx,ŷEf#mm }11픷d}LNѯƜ4c1D tW#Cv;<=D&r^3 9=;0c EvT/De:p yJ63GlRѿ*[u١n.u[]N{BYϨ_䔺W='%9yN;!퓳yzBUCdDfC%Z:YrAJ[ DA:UOn֌߇5&>~v Ds̑]d@jTEkYO 'saգ!A0Gس>uz簙2X3Ayӗ%& ^!Ӄ=$^޿%o ʯ X\cp6>0ȳ$wyYkƱO%fgY̠T9Ӟ|l.\&E昛-nX[E79SBnpθWh9rjvy"qNs*uSLFdQMjߝiɥ6kɫV|j ߾ l|`4`)L 5єTL)5j5 ༥')NB"6b?n73|Cs(KJvtCe?I VVyJڕ Wr}w@"2LO =9Wq|[Ƿ8sM`|0v㺲 tc:^)M換C?! #RḺwy)I!=Ihd;_{W'Bg]f^cHE($Ē^*q}Uԗ 3XZ77yC'=:>+)  ~"u wd+c|qcMQ !oeAKGzgH0Ks,=e!w̥f'hλa^A{zHzIo[yAQOImJ*JU">?WRKo'2O}=CH#16I?/iKD'AP/Wn|\mx1:Gh&gĊ8?V /580/PI@s[zʛ8c|ȝ`de4=iY4k_wr:8p$Gt~{b&>.V]}EFVsOX*<9?}sx]dn\c+. M<b1ށɘB٩Tf2w ٌl=>ZrI4Lb``O|yXsGdc~IҀ6=wuܠӗ1H-DZQ4{DY?KY@ 0g)Sqy 0gMly̽̽ȩ̣5Y| ~t~g*3o %^)gM2-,kY[f^`Koܗ8DZK&?LLd3Ɠdާx}$=.f.+f47>\^0B =%{[k\Hϳc{xt^9#2In|]{#jXrOo8,1f&v?>=}<{8GpC!33ç%fpfzDWDI@~z2(?IWݔ60S"6<7@|HįwҊeָ&Ugrc)"w d@WfH0c8飸MgL3EXtS>_e7ErWȻ!喼Om完"̍"?|pQ=2V񲃲_DzYpX*k/dlU䮔]xVaItϢ}r(qUu&)ܔo}x(*w8[MnE:_ P.+iéIī K} XF`b7TwF GbVc`g/$f{c'ԏpPs'鮎|:Nϝ$;I"w=[2L^2>92ID'gH2?2_L|Yyr_ZXXi /W~eܹeꁝ8Ǒ> C?Y!Y1:ikG]PғaP$so`ڨ:[AKiЄWKJR9  OMiM|pT#`Ӥ/e诒ܮInuؓ{]fus~/ g3q嗀ˤgܲ33Or=h>0@s\fdcFh1T2gj7gWn`2"GkH D% ;q̋鈫vWz2{3sgO>|vkO _P,ԁ_'yCv^?)ԴO|B|Q.ͩ 'W,q[ij/Ef4a +ݐ_R2*s666666666vvvvvvvvv6666>666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH \@\ b Heading 2$<@& 56CJOJQJ\]^JaJDA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List 4@4 ~,Header  H$6/6 ~, Header CharCJaJ4 @4 ~,Footer  H$6/!6 ~,0 Footer CharCJaJH2H ~,0 Balloon TextCJOJQJ^JaJN/AN ~,0Balloon Text CharCJOJQJ^JaJ^T@R^ ~, Block Text# Q'nd]^n CJOJQJH`bH z0 No SpacingCJ_HaJmH sH tH 6U`q6 b Hyperlink >*B*ph:B@: b Body Text >*CJaJ</< bBody Text Char>*CJ<P@< b Body Text 2 dx@/@ bBody Text 2 CharCJaJT/T bHeading 2 Char 56CJOJQJ\]^JaJTT Uej List Paragraph ^CJOJPJQJaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w<v :@ :@7 mo. <|&^ !##,<ABDzEpGIGr%'(*,-.01234678:;=?@BCEFLMl m&#,=C\Fqjr&)+/59<>ADKN/IYv(8  , 8 > ^ j p  # ) IU[|5AGgsyVbhgw~N^eu@P`p_o%H:@G$G$G$G$G$G$G$FFFFFFFFFFFFFFFFFFG$G$G$G$G$G$G$G$G$G$G$G$G$G$X@TXX!@ @ (  V  R?"Text Box 2"`Ð?PK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!H%Gdrs/e2oDoc.xmlSێ }@7vdXqVlSU^~8F ;؛< 3lnVN.tR"4JCA??_(q)ТgMgrA vyg xo$q-s0B2=$e*&Vۈ_ׂu'{da2H>!I^ghoP~¡M%fRcÌ 9\hr8}DVKJ4kQ'{z~:r {4{Fc<∆]AY ]#XMHٽ aGmC:N6!l9npMlZ?XX hI8Ԣ9$@j/=;eɉa St]/_!ҸJd[%偷7TSVz$2p7):#IC%vuA#N,| 2C^{k );G'fPL\[#dqcԏ~PK!/2drs/downrev.xmlLN0DHHܨHTUJmnm!v.pYi4fFL4αt Qz|{F|My}U`݅4B#b !nɢ_8zg7X Q^b52Kq\h0ZN*{v~zFSۛyhaPFY{aGa dY7PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!H%G.drs/e2oDoc.xmlPK-!/2drs/downrev.xmlPK 0(  B S  ?|1; tCheck1Check2Check3Check4Check5Check6Check16Check17 Jw);@0Z9;@p/q/r/s/t/u/& & - z7z77;@, ^ ^ 777;@=*urn:schemas-microsoft-com:office:smarttags PlaceType=*urn:schemas-microsoft-com:office:smarttags PlaceName9*urn:schemas-microsoft-com:office:smarttagsplace 6666^7_7a7b7d7e7g7h7j7k7m788|99;;k?p?@(@4@5@8@;@^7_7|99@(@5@7@8@;@(99: : ##T%T%f%p%(( ) )9+A+++..5.5....//003334t4t444666666^7_7_7b7b7k7??@(@4@;@(99: : ##T%T%f%p%(( ) )9+A+++..5.5....//003334t4t444666666_7k7m788|99j:j:;;7<7<<<<<==>>>>??g?r?@(@,@-@5@6@;@jj*6]kF99]V-YI p )  +bf(R4.=E60Kn* N\X&X3Q&b Z 9lnk[/nڃ^ty|FKm| h h^h`7hH.h 8^8`hH.h L^`LhH.h  ^ `hH.h  ^ `hH.h xL^x`LhH.h H^H`hH.h ^`hH.h L^`LhH. ^`>*o(wh. h^h`hH. 8L^8`LhH. ^`hH.  ^ `hH.  L^ `LhH. x^x`hH. H^H`hH. L^`LhH.h^h`o(. 8^8`hH. L^`LhH.  ^ `hH.  ^ `hH. xL^x`LhH. H^H`hH. ^`hH. L^`LhH.0^0`o(. ^`hH. L^`LhH. ^`hH. p^p`hH. @ L^@ `LhH. ^`hH. ^`hH. L^`LhH.h^`OJQJo(hHhh^h`OJQJ^Jo(hHoh8^8`OJQJo(hHh^`OJQJo(hHh ^ `OJQJ^Jo(hHoh ^ `OJQJo(hHhx^x`OJQJo(hHhH^H`OJQJ^Jo(hHoh^`OJQJo(hHhh^h`7B*o(phhH.h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH0^0`>*o(. ^`hH. L^`LhH. ^`hH. p^p`hH. @ L^@ `LhH. ^`hH. ^`hH. L^`LhH.h^h`OJQJo(hH8^8`OJQJ^Jo(hHo^`OJQJo(hH ^ `OJQJo(hH ^ `OJQJ^Jo(hHox^x`OJQJo(hHH^H`OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH^`CJo(. h^h`hH. 8L^8`LhH. ^`hH.  ^ `hH.  L^ `LhH. x^x`hH. H^H`hH. L^`LhH.0^0`CJo(. ^`hH. L^`LhH. ^`hH. p^p`hH. @ L^@ `LhH. ^`hH. ^`hH. L^`LhH.0^0`o(. ^`hH. L^`LhH. ^`hH. p^p`hH. @ L^@ `LhH. ^`hH. ^`hH. L^`LhH.hhh^h`OJQJo(hHh88^8`OJQJ^Jo(hHoh^`OJQJo(hHh  ^ `OJQJo(hHh  ^ `OJQJ^Jo(hHohxx^x`OJQJo(hHhHH^H`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hH0^`CJo(.0 ^`hH.0 L^`LhH.0 p^p`hH.0 @ ^@ `hH.0 L^`LhH.0 ^`hH.0 ^`hH.0 L^`LhH. 0^0`5CJo(. ^`hH. L^`LhH. ^`hH. p^p`hH. @ L^@ `LhH. ^`hH. ^`hH. L^`LhH. +n* N )k[/n=E jj*F9(R4 9l&bKm|-YI ]k&X3Qty|9]wXGbUXä 2&1&1&e                         ]                          4                          {V        q                         {V        J        ?Q8?kqnD J r No(=z%%m}o "_"}#d' ^) +++.+~,,/z0547v4x59w.:P:Mt=L??t? ACRDXDs\LEMNS\Qb_QpQWG9Z@[,\4\A]!arKa|a:d,/itiPjUej-m m]6mBoxqrQtXMu'PvRvf{vRXo #lv< 9041!93VO55@S/]@Au -L|FFj@G< Ye+WU_g>Qa1"0nk*f|3G%&eQfGh@3*bbH Z&oP<U_7a7@p ;:@@@@ @Unknownpaula.woodworthG.[x Times New Roman5Symbol3. .Cx Arial5. .[`)Tahoma7.*{$ Calibri?= .Cx Courier New;WingdingsA$BCambria Math"1hkk#\'C/dC/d!`x4C7C7 2qHP?Qt2!xx -Licensed or Certified Provider Agreement Form Tamara.WilsonBanks, Melissa (CHFS DCBS DCC)L           ?@ABCDEFGHIJKLMNOQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry F4! Data Pgp1Tablec_WordDocumentkSummaryInformation('DocumentSummaryInformation8MsoDataStore4!4!HRAONDPU0HFTQVQ==2 4!4!Item  PropertiesRKANUF45Z==2 4!4!Item  Properties FCQYEVUY02VQ==24!4!Item 7$Properties &()*+,-. ds:schemaRefs>DocumentLibraryFormDocumentLibraryFormDocumentLibraryFormtype/forms">DocumentLibraryF ds:itemID="{DD0FD4BD-5468-47D5-B5B0-E2EF0C259EE6}" xml s> ds:schemaRefs> This value indicates the number of saves or revisions. The application is responsible for updating this value after each revision. t ref="dc:subject" minOccurs="0" maxOccurs="1"/> This value indicates the number of saves or revisions. The application is responsible for updating this value after each revision. metaAttributes"/>  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q Oh+'0CompObj%r|   , 8 D P\dltTamara.WilsonNormal Banks, Melissa (CHFS DCBS DCC)2Microsoft Office Word@@G@͈@͈C/dcc94b