Get the StateFarm ATPT Form 2004-2020
THE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. SIGNATURE OF PROVIDER DATE ATPT Form Version 1. ATTENDING PROVIDER TREATMENT PLAN INITIAL SUBMISSION FOLLOW-UP SUBMISSION TYPE OR PRINT LEGIBLY CLAIM PATIENT INFORMATION 1. PATIENT S NAME Last 12. DATE OF ACCIDENT DATE SUBMITTED 13. IS PATIENT S CONDITION RELATED TO 2. PATIENT S ADDRESS No* Street 3. CITY 4. STATE A. EMPLOYMENT 6. TELEPHONE Include Area Code 8. SEX M 9. S*S* NUMBER 20. ZIP CODE NO C. OTHER ACCIDENT Y...
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Hi everyone thanks for joining me for thisdemonstration of the new Form PI-1 General Application or PI-1 for short In this module I'll be showing you the Generalsheet This sheet includes questions to identifywhat is being applied for and to provide necessary administrative information Throughout the workbook all yellow cells shouldbe completed by the applicant unless noted otherwise Questions will grey out based on responsesto previous questions I'll know show you some of the main questionsand features of this sheet On each data entry sheet there is an unlockedcolumn for Applicant Internal comments This is an optional area to be used by consultantsand applicants as they prepare their application All notes should be deleted prior to submittal This column is not an appropriate locationto make notes to TCEQ staff This row is important All PI-1s must be confirmed to be the officialTCEQ version by selecting 'I agree' I entered example applicant information soyou can see some of the data fields as I scroll through the administrative information Section III the Permit Information sectionis very important For each permit type the applicant shouldindicate the action type requested No entry can be left blank in this sectionto ensure correct conditional formatting is applied throughout the workbook For example questions related to renewalswill be greyed out if renewal is not selected for any permit type In this example I'll select an amendmentfor a minor NSR permit You can see that now I can enter the permitnumber I've indicated all the other permit typesare not applicable since I'm not applying for any actions for those The next questions are for other categoriessuch as MSS activities Consolidation of NSR permits Incorporation of standard permitsstandard exemptions andor permits by rule and that can be done by reference or by consolidation And federal operating permits Here in the location area I used the dropdownlist to select the county where the facility is located in this example we'll selectHarris The rows below are filled in with the appropriateTCEQ region and with the current classification for nonattainment In this case it is moderate ozone for nonattainment There are other questions related to the facilityand site location Here in the project information section we'llenter a description of the project we are applying for We are looking for something brief and completedescribing the what not the how and why For example in this project description I'veindicated that I'm increasing the hours of operation of a turbine I did not list why or how it will be calculated You can expand the row height as needed toshow the full description And there are some additional project questions The application materials section lists differentmaterials that may be submitted with the PI-1 The preferred method for submitting all ofthese materials is via email and instructions to do so are included on the Cover sheet For each...