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 6343.13 - Application Process For Payment Standards For Secure Transportation Services

(a) Applicants who seek initial certification for payment standards for secure 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 the 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 services based on the criteria in (b) above, DCYF shall forward an application packet to the applicant, which shall include:

(d) Each applicant shall submit a completed Form 2613 "Application for Certification and Enrollment of Secure Transportation Service Providers" (March 2019) to DCYF within 30 days of receipt, together with a completed "State of New Hampshire Alternate W-9" (October 2016) .

(e) Each applicant shall sign and date Part B: "Authorization/Statement of Understanding" of Form 2613 "Application for Certification and Enrollment of Secure Transportation Service Providers" (XXXXX 2019) certifying the following:

"I have reviewed the Administrative Rules He-C 6343 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 Rules He-C 6343. 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."