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x Direct Bill Account - Application Form
(Please print clearly all personnel names). Authorization to Direct Bill Charges for ongoing events, sleeping rooms, catering, meeting rooms. Please Bill to
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Direct Payment Authorization Form
Completing the Direct Payment Authorization form (CalPERS-1008). Contact your current or former employing agencys Health Benefits Officer/Personnel Office
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Electronic Funds Transfer Authorization Form
To request EFT of New York Medicaid funds, complete all sections of the form below. Questions about completing this form should be directed to eMedNY Call
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