Form FA-34 Provider Voluntary Termination Notice - Nevada

What Is Form FA-34?

This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form FA-34 Provider Voluntary Termination Notice?
A: Form FA-34 Provider Voluntary Termination Notice is a document used in Nevada to notify the state authorities about the voluntary termination of a provider.

Q: Who needs to fill out Form FA-34 Provider Voluntary Termination Notice?
A: Form FA-34 Provider Voluntary Termination Notice needs to be filled out by providers in Nevada who wish to voluntarily terminate their services.

Q: What information is required in Form FA-34 Provider Voluntary Termination Notice?
A: Form FA-34 Provider Voluntary Termination Notice requires information such as the provider's name, address, Medicaid provider number, and the effective date of termination.

Q: What is the purpose of Form FA-34 Provider Voluntary Termination Notice?
A: The purpose of Form FA-34 Provider Voluntary Termination Notice is to formally notify the state authorities about the voluntary termination of a provider's services in Nevada.

Q: Are there any fees associated with submitting Form FA-34 Provider Voluntary Termination Notice?
A: No, there are no fees associated with submitting Form FA-34 Provider Voluntary Termination Notice.