New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-C - Commissioner, Department of Health and Human Services
Chapter He-C 6300 - GENERAL PROGRAM ADMINISTRATION
Part He-C 6343 - CERTIFICATION PAYMENT STANDARDS FOR TRANSPORTATION SERVICE PROVIDERS
Section He-C 6343.11 - Application Process For Payment Standards For Private Vehicle Transportation Services

(a) Individual applicants who seek initial certification for the provision of private transportation services shall contact a DCYF district office supervisor or designee and request to be referred for certification.

(b) The DCYF district office supervisor or DCYF community, family, and program support certification specialist shall assess the need for services, based on the following criteria:

(c) If there is a need for a service based on (b) above, DCYF shall forward an application packet to the applicant which includes:

(d) Each applicant shall complete and submit Form 2615 "Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers" (March 2019) to DCYF within 30 days of receipt, together with all the attachments in He-C 6343.11(g) .

(e) Each applicant shall sign and date Part C: "Applicant Information" of Form 2615 "Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers" (March 2019) certifying the following:

"I declare that all the information contained above is true, correct and complete to the best of my knowledge and belief. I acknowledge that the provision of false information in the application is a basis for denial of the application."

(f) Each applicant shall sign and date Part D: "Authorization/Statement of Understanding" of Form 2615 "Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers" (March 2019) certifying the following:

"I have reviewed the Administrative Rule He-C 6343, Certification for Payment Standards for Transportation Service Providers and will adhere to the rules as a certified provider. I authorize the NH Division for Children, Youth and Families (DCYF) to conduct a certification for payment review to determine the program's compliance with Administrative Rule He-C 6343, Certification for Payment Standards for Transportation Service Providers. I further understand that DCYF has the right to verify information contained in this application.

The information contained in this application is correct to the best of my knowledge. I acknowledge that the provision of false information in the application is a basis for denial of the application."

(g) Each applicant shall submit the following with Form 2615 "Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers" (March 2019):