You will need to enter your Unique Patient ID (UPI) number in order to complete the audit form below. Your UPI was indicated on your 2022 grant notification letter and is also on the memo line of each CARE grant check.
A COMPLETE AUDIT FORM IS REQUIRED BY NO LATER THAN 12:00pm ET JUNE 1, 2022 IN ORDER TO RECEIVE ANY FURTHER NGCF PREMIUM ASSISTANCE.
It is the grantee’s responsibility to ensure this required audit is completed on time. Please note that CARE grant recipients who submit forms after the June 1 deadline will forfeit their July premium assistance.
If you have any questions, please contact Noreen Layne directly at 301-900-1050 or through the CARE line at 301-900-1053. You may also contact us at firstname.lastname@example.org.
Thank you for your prompt attention and submission of the required Audit Form with POI. We look forward to receiving it by June 1, 2022 and continuing to disseminate your 2021 premium assistance.