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This version of the form is not currently in use and is provided for reference only. Download this version of
Form ODM02219
for the current year.
Form ODM02219 Affidavit of Tax Payment Compliance for Non-agency Odm-Administered Waiver Service Providers - Ohio
What Is Form ODM02219?
This is a legal form that was released by the Ohio Department of Medicaid - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form ODM02219?
A: Form ODM02219 is the Affidavit of Tax Payment Compliance for Non-agency ODM-Administered Waiver Service Providers in Ohio.
Q: Who is required to fill out this form?
A: Non-agency ODM-Administered Waiver Service Providers in Ohio are required to fill out this form.
Q: What is the purpose of this form?
A: The purpose of this form is to ensure that non-agency waiver service providers are in compliance with their tax payments.
Q: Do I need to submit any supporting documents with this form?
A: Yes, you may need to submit additional supporting documents as specified in the form instructions.
Q: Are there any deadlines for submitting this form?
A: The form should be submitted according to the deadlines specified by the Ohio Department of Medicaid.
Q: What happens if I do not submit this form?
A: Failure to submit this form or providing false information may result in penalties or other consequences.
Q: Is this form applicable to agency-administered waiver service providers?
A: No, this form is specifically for non-agency ODM-administered waiver service providers.
Q: Who can I contact for further assistance with this form?
A: For further assistance with this form, you can contact the Ohio Department of Medicaid or refer to the form instructions for contact information.
Form Details:
- Released on December 1, 2015;
- The latest edition provided by the Ohio Department of Medicaid;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form ODM02219 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.
