notarized certification of non enrollment
Exhibit 5-3: Acceptable Forms of Verification
If applicable, docHubd statement or affidavit from applicant indicating that payments are not being received and describing efforts to collect amounts due.
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NEW YORK STATE MEDICAID PROGRAM BILLING
May 9, 2005 All providers, either direct billers or those who billed through a service bureau or clearinghouse, must file a docHubd Certification
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Instructions for Completing application for non degree schools
The Affirmation by All Filers clause must be docHubd. 4. Certification. Application Form. Complete the Certification Application Form for Non-Degree Schools
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