Waiver occurrence review

Decision

Select your decision on the provider's request for a waiver or variance. This field is required.

Type

Select the type of request. This field is required.

State of Waiver/ Variance

Select the status of this waiver or variance request.

Accepted Effective Date

If you are approving the request, enter the date on which this waiver or variance is effective. Use the format MM/DD/YYYY. This field is required.

//SME: Is this correct? What's this field for?//

Accepted Expiration Date

If you are approving a waiver request, enter the date on which the waiver expires. Use the format MM/DD/YYYY.

Rule Chapter

Select the chapter of the rule from which the provider is requesting a waiver or variance. This field is required.

Rule Section

Select the section of the rule from which the provider is requesting a waiver or variance. This field is required.

Rule Sub-Section

Select the subsection of the rule from which the provider is requesting a waiver or variance.

Explain (ODJFS Comments)

As the ODJFS reviewer, enter any additional information about this request. You can enter up to XX characters.

//SME: What's the field length?//

Explain (Agency Comments)

As the agency worker who requested the waiver or variance on behalf of the provider, enter any additional information. You can enter up to XX characters.

//SME: What's the field length?//