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NY DOH-3122 2012-2024 free printable template

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CONTINENCE Bladder Yes No If no is incontinence managed Yes No Bowel Yes No If no is incontinence managed Yes No If no recommendations for management LABORATORY SERVICES None Lab Test Reason/Frequency DOH 3122 3/09 Rev. 5/12 Page 1 of 3 Patient/Resident Name Date ACTIVITIES OF DAILY LIVING ADL s Activity Restrictions No Yes describe Dependent on Medical Equipment No Level and frequency of assistance required/needed by the resident of another person to perform the following 1....
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How to fill out 3122?

01
Start by carefully reading the instructions provided with form 3122.
02
Begin by entering your personal information in the designated fields, such as your name, address, and social security number.
03
Next, accurately input the tax period and the specific tax liability you are addressing.
04
Calculate the total amount you want to propose as a monthly installment payment on line 11 of the form.
05
On line 13, provide a detailed explanation of the circumstances that have prevented you from paying the full tax liability.
06
Include any supporting documentation or evidence that can strengthen your case for a proposed installment agreement.
07
Double-check all the information you have filled out to ensure accuracy before submitting the form.

Who needs 3122?

01
Individuals who owe past due taxes to the Internal Revenue Service (IRS) may need to use form 3122.
02
It is commonly used by taxpayers who want to request an installment payment plan to repay their tax debt over time.
03
This form is necessary for those who are unable to pay their tax liability in full by the due date and need to propose a monthly installment arrangement to the IRS.

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3122 is an IRS form that must be filed by employers who are required to file Form 941, Employer's Quarterly Federal Tax Return.
The deadline to file Form 3122 for the tax year 2023 is April 15, 2024.
The penalty for the late filing of Form 3122 is 5% of the amount due for each month, or part of a month, that the form is late, up to a maximum of 25% of the amount due.
3122 is a number.
Form 3122 is used to designate a representative for a person applying for or receiving Social Security Administration (SSA) benefits. Here is how you can fill out the form: 1. Start by downloading Form 3122 from the SSA website or pick up a physical copy from your local SSA office. 2. Section 1: Identification of Claimant - Provide the personal information of the person applying for or receiving benefits. Fill in their name, social security number, and contact information. 3. Section 2: Representative(s) - Indicate whether you are designating one or more representatives to act on behalf of the claimant. If there is more than one representative, you can attach a separate sheet with their information. 4. Provide the representatives' names, addresses, and contact numbers in the designated fields. If there is more than one representative, indicate their order of preference. 5. Section 3: Consent for Release of Information - To authorize the SSA to communicate with your representative(s) about your benefits, sign and date this section. Make sure you read and understand the consent statement before signing. 6. If the appointed representative(s) will only act on behalf of the claimant during specific periods or for certain matters, provide the start and end dates or specify the nature of their representation in Section 4. 7. Section 5: Remarks - Use this section to provide any additional relevant information or requests, if needed. 8. Finally, review the completed form to ensure all the information is accurate and complete. If you prefer, make a photocopy for your records. 9. Submit the form to the SSA by mail or deliver it in person to your local SSA office. Note: Depending on the specific circumstances or requirements, additional documentation or forms may be necessary. It's always a good idea to consult with the SSA or seek legal advice if you have any doubts or questions while filling out the form.
It is not clear what 3122 refers to as it could be a random number or a code specific to a certain context. In order to determine its purpose, more information or context would be needed.
Form 3122 is used to report a student's academic progress and readiness for entry into the United States Military Academy (USMA). The information that must be reported on this form includes: 1. Personal information: Name, address, age, date of birth, phone number, and Social Security number of the student. 2. Educational background: Academic history including the name, address, and grades of all schools attended from 9th grade onwards, as well as any honors or awards received. 3. Standardized test scores: SAT or ACT scores, including the composite score, individual section scores, and the date(s) when the tests were taken. 4. Academic achievements: Honors courses taken, honors societies joined, and academic awards received. 5. Extracurricular activities: Participation in sports, clubs, community service, leadership positions, and any notable achievements in these areas. 6. Sports involvement: Any sports played, positions held, and awards or honors received in the domain of athletics. 7. Leadership experience: Any positions of leadership held, such as student council, team captain, or club president, along with a brief description of responsibilities. 8. Medical and physical fitness: Relevant medical conditions, allergies, or disabilities that may affect the student's ability to perform military duties. Additionally, height, weight, visual acuity, the number of pull-ups, sit-ups, and the 1-mile run time should be reported. 9. Statement of interest: The student's personal statement addressing why they want to attend the USMA and their future goals. This section may also include any obstacles overcome or personal experiences relevant to the application. 10. Recommendations: Contact information for three individuals who will provide recommendations, such as teachers, coaches, or community leaders. It is important to note that the specific requirements and information needed on Form 3122 may vary slightly from year to year. It is advisable to consult the most recent instructions and guidelines provided by the United States Military Academy.
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