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New York State Medicaid Program: Transportation Manual
Nov 1, 2012 form of surety bonds, to be required as a condition of participation or way pick-up fee plus $1.00 per loaded mile. Ace is authorized to
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AUTHORIZATION for PICKING UP PAYCHECKS
The completed form, along with the written (not stamped) signature, must be REMINDER: Please remember photo ID is required to pick up paychecks. Paycheck pick
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Authorization for Payroll Check Pick-up form
AUTHORIZATION FOR CENTRAL PAYROLL. CHECK AND DOCUMENTATION PICK-UP. WORK/PAY LOCATION CODE: DATE:
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