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Pa nurse service 2026
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- Click ‘Get Form’ to open the Purchase of Pennsylvania County Nurse Service form in the editor.
- Begin by filling out the Member Information section. Ensure your name, address, Social Security number, and contact details are accurate. If there are any discrepancies, contact your employer for corrections.
- In the Member Certification section, sign and date the form. This certifies your request for cost information regarding service credit purchase and confirms your ineligibility for an annuity based on this service.
- Complete the Employment Information section with details about your county nurse service. Your employer must provide specifics such as county name, school year, employment type (full-time or part-time), wage type, and expected units of service.
- Ensure that your employer fills out the Employer Certification section accurately. They must sign and date it to confirm all provided information is correct.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2015 | 4.8 Satisfied (60 Votes) |
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pa purchase service form
The home health care agency shall provide skilled nursing services by or under the supervision of a registered nurse and in accordance with the plan ofRead more
The Pennsylvania State Board of Nursing is responsible for regulating practice of nursing and dietetics-nutrition. Call us 1-833-DOS-BPOA - Available Monday -