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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 OR-PS (150-101-190)
for the current year.
Form OR-PS (150-101-190) Care Provider Statement - Oregon
What Is Form OR-PS (150-101-190)?
This is a legal form that was released by the Oregon Department of Revenue - a government authority operating within Oregon. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form OR-PS (150-101-190)?
A: Form OR-PS (150-101-190) is the Care Provider Statement used in Oregon.
Q: Who needs to fill out Form OR-PS?
A: Form OR-PS needs to be filled out by care providers in Oregon who have provided services to the recipient of care.
Q: What information is required on Form OR-PS?
A: Form OR-PS requires information such as the care provider's name, address, Social Security number, and the recipient's name and Medicaid ID.
Q: Is Form OR-PS mandatory?
A: Yes, Form OR-PS is mandatory for care providers who have provided services to Medicaid recipients in Oregon.
Form Details:
- Released on June 24, 2021;
- The latest edition provided by the Oregon Department of Revenue;
- 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 OR-PS (150-101-190) by clicking the link below or browse more documents and templates provided by the Oregon Department of Revenue.
Download Form OR-PS (150-101-190) Care Provider Statement - Oregon
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