Form Hpz-034-A-Pf - Arizona Taxonomy Of Human Services - Request For A New Or Revised Program/cluster/service

Download a blank fillable Form Hpz-034-A-Pf - Arizona Taxonomy Of Human Services - Request For A New Or Revised Program/cluster/service in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Hpz-034-A-Pf - Arizona Taxonomy Of Human Services - Request For A New Or Revised Program/cluster/service with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

HPZ-034-A-PF (10-16)
Arizona Taxonomy of Human Services
Request for a New or Revised Program/Cluster/Service
Please complete all the information on this form and forward to the Arizona Taxonomy Committee Chairperson.
Recommendations for new or revised services should be received prior to September of each calendar year in order
to ensure inclusion in the document.
Name of Agency/Department/Administration requesting change:
Contact person:
Telephone:
Mailing address:
Name of individual Taxonomy Committee
member submitting the request:
Name of ATC member submitting the request:
Program/Service Title (Proposed or existing):
Proposed Program/Service description:
Proposed Taxonomy Reporting Measure (TRM):
Service Code Number (If modifying an existing service):
Proposed Location in Taxonomy:
Cluster:
Program:
CRITERIA FOR A SERVICE:
The following criteria apply to all services to be added or modified in the Arizona Taxonomy of Human Services.
A service and program description is general, mutually exclusive and states what is provided.
The Service/Program description is:
mutually exclusive or discrete
Yes
No
non-target group specific
Yes
No
non-setting specific
Yes
No
non-funder specific
Yes
No
activity-based (level of intensity may vary)
Yes
No
required by federal law*
Yes
No
Source:
Yes
No
Required by State Statute*
Source:
*Attach Documentation of federal/state requirement.
See page 2 for EOE/ADA/LEP/GINA disclosures

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Il444-3455 - Child Care Application - Department Of Human Services - Bureau Of Child Care And Development Form Il444-3455 - Child Care Application - Department Of Human Services - Bureau Of Child Care And Development Legal
Form Il444-3455e - Child Care Redetermination - Department Of Human Services - Bureau Of Child Care And Development Form Il444-3455e - Child Care Redetermination - Department Of Human Services - Bureau Of Child Care And Development Legal
Form Fqa-063 - Microbiology Submission - Arizona Department Of Health Services Form Fqa-063 - Microbiology Submission - Arizona Department Of Health Services Legal
Form Veh 01 - Transport Application Form To Register A New Or Used Vehicle Form Veh 01 - Transport Application Form To Register A New Or Used Vehicle Legal
Request For A Fair Hearing - Oklahoma Department Of Human Services Request For A Fair Hearing - Oklahoma Department Of Human Services Legal
Form Soc 2272b - In-home Supportive Services Program Notice To Recipient Acknowledgement Of Provider's Request For County Violation Review For Exceeding Workweek And/or Travel Time Limits Form Soc 2272b - In-home Supportive Services Program Notice To Recipient Acknowledgement Of Provider's Request For County Violation Review For Exceeding Workweek And/or Travel Time Limits Legal
Form Fda 356h - Application To Market A New Or Abbreviated New Drug Or Biologic For Human Use Form Form Fda 356h - Application To Market A New Or Abbreviated New Drug Or Biologic For Human Use Form Legal
Request For Medical Authorization - State Of Hawaii Acs Department Of Human Services Request For Medical Authorization - State Of Hawaii Acs Department Of Human Services Business
Request Form For Prior Authorization Nonsteroidal Anti-inflammatory Drugs - Iowa Department Of Human Services Request Form For Prior Authorization Nonsteroidal Anti-inflammatory Drugs - Iowa Department Of Human Services Legal
Request For Redetermination Information - Illinois Departament Of Human Services Request For Redetermination Information - Illinois Departament Of Human Services Legal

Related Categories

Parent category: Legal
Download
Go
Page of 2