PDF
Word
Form DHS-4646-ENG Child and Teen Checkups (C&tc) Provider Agreement Addendum - Minnesota Health Care Programs (Mhcp) - Minnesota
What Is Form DHS-4646-ENG?
This is a legal form that was released by the Minnesota Department of Human Services - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the purpose of Form DHS-4646-ENG?A: The purpose of Form DHS-4646-ENG is to provide an addendum to the Child and Teen Checkups (C&tc) Provider Agreement for Minnesota Health Care Programs (Mhcp) in Minnesota.
Q: Who should use Form DHS-4646-ENG?A: Form DHS-4646-ENG should be used by providers participating in the Child and Teen Checkups (C&tc) program under the Minnesota Health Care Programs (Mhcp).
Q: What does the form cover?A: Form DHS-4646-ENG covers the additional terms and conditions that apply specifically to providers participating in the Child and Teen Checkups (C&tc) program in Minnesota.
Q: Do I need to submit Form DHS-4646-ENG?A: Yes, providers participating in the Child and Teen Checkups (C&tc) program in Minnesota are required to submit Form DHS-4646-ENG along with the Provider Agreement.
Q: Are there any other documents required?A: In addition to Form DHS-4646-ENG and the Provider Agreement, providers may be required to submit other supporting documentation as specified by the C&tc program administration.
Q: Can I make changes to the form?A: No, providers are not allowed to make any changes to the content of Form DHS-4646-ENG. The form must be completed as is.
Q: What happens after I submit Form DHS-4646-ENG?A: Once Form DHS-4646-ENG is submitted along with the Provider Agreement and any other required documentation, the C&tc program administration will review the application and notify the provider of its status.
Q: What if I have questions about the form?A: If you have any questions about Form DHS-4646-ENG or the Child and Teen Checkups (C&tc) program, you should contact the C&tc program administration or the Minnesota Department of Human Services for assistance.
Form Details:
- Released on November 1, 2022;
- The latest edition provided by the Minnesota Department of Human 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 DHS-4646-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.
