Form 2617R Certification Renewal - Private Behavioral Health Services Providers - New Hampshire

What Is Form 2617R?

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

FAQ

Q: What is Form 2617R?
A: Form 2617R is the certification renewal form for private behavioral health services providers in New Hampshire.

Q: Who needs to complete Form 2617R?
A: Private behavioral health services providers in New Hampshire need to complete Form 2617R for certification renewal.

Q: What is the purpose of Form 2617R?
A: The purpose of Form 2617R is to renew the certification of private behavioral health services providers in New Hampshire.

Q: What information is required on Form 2617R?
A: Form 2617R requires information about the provider's organization, services provided, and compliance with regulations.

Q: When is Form 2617R due?
A: Form 2617R is due on the provider's certification renewal date, which is typically one year after the initial certification.

Q: Are there any fees associated with Form 2617R?
A: Yes, there is a certification renewal fee that needs to be submitted along with Form 2617R.

Q: What happens if Form 2617R is not submitted on time?
A: If Form 2617R is not submitted on time, the provider's certification may expire, and they may not be able to continue providing private behavioral health services.

Q: Can Form 2617R be appealed?
A: Yes, if Form 2617R is denied, the provider can appeal the decision through the New Hampshire Division of Behavioral Health's appeal process.