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How to use or fill out DLN Individual PASRR Level 1 Screening Section A Submitter Information (NF/LA only) A0100
- Click ‘Get Form’ to open it in the editor.
- Begin with Section A, where you will enter the submitter's information. Fill in your name, title, and contract number as required.
- Complete the address fields including street address, city, state, and ZIP code. Ensure accuracy for proper communication.
- Provide details about the referring entity by filling out their name, address, and phone number in the Referring Entity Information section.
- In the Personal Information section for the individual being screened, input their first name, last name, social security number, and other relevant personal details.
- Review all entries for completeness and accuracy before proceeding to sign and certify the information provided.
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