b) On or before the last day of September, December, March and June a nursing home that is a distribution agent under the Act shall file with the Department Form NH-1 of the Certification. Form NH-1 of the Certification shall contain the following information:

1. 1) the total number of occupied bed days during the quarter, multiplied by $1.00;
2. 2) the total amount of the fee due to the Department.

c) On or before the last day of September, December, March and June a nursing home that is a distribution agent under the Act shall file with the Department Form NH-2 of the Certification. Form NH-2 of the Certification shall contain the following information:

1. 1) Distribution Agent Information. The Certification shall contain the name and address of the distribution agent, as well as:

   1. A) the number of the license issued to the distribution agent under the Nursing Home Care Act by the Illinois Department of Public Health;
   2. B) the distribution agent's Federal Employer Identification Number; and
   3. C) the distribution agent's Illinois Business Identification Number.

2. 2) Total Grant Calculation. The Certification shall disclose, for the quarter immediately preceding the quarter for which a certification is filed:

   1. A) the name and social security number of each eligible individual and the total number of eligible individuals for whom a written authorization has been executed and is maintained on file as required by Section 535.110 of this Part; and
   2. B) the total number of occupied bed days for each eligible individual included in the Certification, and the total number of occupied bed days for all eligible individuals.