Attestation Form: High School Diploma/GED Requirement
This file is an attestation form required for employees without a high school diploma or GED. It ensures the employee meets the minimum requirements to provide services under the Home and Community Based Waiver for Individuals with Intellectual and Developmental Disabilities. The form must be signed and retained by the agency.
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How do I fill this out?
Filling out this form is simple. You'll need to provide basic information about the employee and attest to their eligibility for the position. Ensure all required fields are accurately completed before signing.
How to fill out the Attestation Form: High School Diploma/GED Requirement?
1
Enter the provider agency name.
2
Enter the employee's name.
3
Specify the employee's position title.
4
Complete the attestation section.
5
Print, sign and date the form.
Who needs the Attestation Form: High School Diploma/GED Requirement?
1
Provider agencies needing to verify employee qualifications.
2
Employees without a high school diploma or GED, who meet job requirements.
3
HR departments required to maintain personnel files with this attestation.
4
Auditors during compliance checks for employee qualification documentation.
5
Regulatory bodies overseeing Home and Community Based Waiver compliance.
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1
Upload the PDF form to PrintFriendly.
2
Open the form in our PDF editor.
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Fill out the required fields.
4
Make any necessary edits to the document.
5
Save and download the completed form.
What are the instructions for submitting this form?
Submit the completed form to the appropriate department within your agency. Forms can be submitted via email, fax, or in-person. For email submissions, attach the completed form and send it to your HR representative. For fax submissions, use the agency's designated fax number. Ensure the form is signed before submission. It's advisable to keep a copy for your records. Contact your HR department for specific submission addresses or additional guidance.
What are the important dates for this form in 2024 and 2025?
Ensure to check with your agency for specific submission deadlines and compliance dates applicable to the Home and Community Based Waiver program in 2024 and 2025.
What is the purpose of this form?
The purpose of this attestation form is to provide documentation for employees who do not possess a high school diploma or GED. This form ensures that such employees meet the minimum requirements to provide services under the Home and Community Based Waiver for Individuals with Intellectual and Developmental Disabilities. By completing and signing this form, the provider agency verifies the employee's qualifications, ensuring compliance with state health department standards.
Tell me about this form and its components and fields line-by-line.
- 1. Provider Agency Name: The name of the agency providing services under the waiver program.
- 2. Employee Name: The full name of the employee being attested.
- 3. Position Title of Employee: The job title held by the employee.
- 4. Attestation: A statement confirming the employee's lack of high school diploma or GED and their qualification for the position.
- 5. Signatures: The form must be signed by an authorized representative of the agency.
What happens if I fail to submit this form?
Failure to submit this form can result in non-compliance with state regulations.
- Non-Compliance: The agency may be out of compliance with state requirements for employee qualifications.
- Service Disruption: The employee may not be authorized to provide services, potentially disrupting care for participants.
- Audit Issues: Lack of proper documentation can lead to issues during audits by regulatory bodies.
How do I know when to use this form?
- 1. New Employee Onboarding: Complete this form for new hires lacking a high school diploma or GED.
- 2. Annual Compliance Checks: Use during annual reviews to ensure ongoing compliance with employee qualifications.
- 3. State Audits: Submit this form during state audits to verify employee qualifications.
Frequently Asked Question
How do I fill out the attestation form?
Enter the agency and employee details, complete the attestation section, and sign the form.
Can I sign the form electronically?
Yes, PrintFriendly supports electronic signatures that are accepted as original signatures.
How do I share the completed form?
You can share the form via email or download it for direct distribution using PrintFriendly's sharing options.
What do I do if I need to edit the form?
Use PrintFriendly's PDF editor to make changes before finalizing and saving the document.
Who needs to fill out this form?
Provider agencies, employees without a high school diploma or GED, HR departments, auditors, and regulatory bodies.
How do I know the form is completed correctly?
Ensure all required fields are filled accurately and the form is signed.
Can I save my work and continue later?
Yes, you can save your progress and continue editing at any time using PrintFriendly's PDF editor.
Is there a way to track the submission of the form?
Track your form submissions through your PrintFriendly account for easy access and record-keeping.
Can I use this form for verification purposes?
Yes, the form is used to verify employee qualifications under the Home and Community Based Waiver program.
What happens if I submit an incomplete form?
Ensure the form is fully completed before submitting to avoid any compliance issues.
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