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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 DDAP-EFM-1301
for the current year.
Form DDAP-EFM-1301 Gambling Treatment Program Provider Application - Sole Practitioner - Pennsylvania
What Is Form DDAP-EFM-1301?
This is a legal form that was released by the Pennsylvania Department of Drug and Alcohol Programs - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DDAP-EFM-1301?
A: Form DDAP-EFM-1301 is the Gambling Treatment Program Provider Application for Sole Practitioner in Pennsylvania.
Q: Who is this form for?
A: This form is for sole practitioners in Pennsylvania who wish to become a provider for the Gambling Treatment Program.
Q: What does the form require?
A: The form requires personal and contact information, qualifications and experience, business details, and a signature.
Form Details:
- Released on January 1, 2019;
- The latest edition provided by the Pennsylvania Department of Drug and Alcohol Programs;
- 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 DDAP-EFM-1301 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Drug and Alcohol Programs.
Download Form DDAP-EFM-1301 Gambling Treatment Program Provider Application - Sole Practitioner - Pennsylvania
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