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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 CERT-47
for the current year.
Form CERT-47 Individual Care Coordinator Conflict of Interest Assurance - Alaska
What Is Form CERT-47?
This is a legal form that was released by the Alaska Department of Health and Social Services - a government authority operating within Alaska. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the CERT-47 Individual Care Coordinator Conflict of Interest Assurance?
A: The CERT-47 Individual Care Coordinator Conflict of Interest Assurance is a form used in Alaska.
Q: What does the form entail?
A: The form requires the individual care coordinator to disclose any conflicts of interest they may have.
Q: Why is the form important?
A: The form is important as it helps ensure transparency and accountability in the provision of care coordination services.
Q: Who needs to complete the form?
A: Individual care coordinators in Alaska need to complete the form.
Q: Is the form mandatory?
A: Yes, the form is mandatory for individual care coordinators in Alaska.
Q: Are there any consequences for not completing the form?
A: Individual care coordinators may face disciplinary action or lose their certification if they fail to complete the form.
Q: Are there any fees associated with the form?
A: There are no fees associated with the completion of the form.
Form Details:
- Released on February 14, 2020;
- The latest edition provided by the Alaska Department of Health and Social Services;
- 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 CERT-47 by clicking the link below or browse more documents and templates provided by the Alaska Department of Health and Social Services.
