1. (a) Transportation service providers shall complete and submit Form 2616R “Review of Continued Certification for Transportation Service Providers” (March 2019) as provided by DCYF within 30 days of the receipt.

2. (b) Part C of Form 2616R “Review of Continued Certification for Transportation Service Providers” (March 2019) shall be signed and dated by each direct service staff of accompanied transportation services providers certifying the following affirmation:

   “I declare that all the information contained above is true, correct, and complete to the best of my knowledge and belief. I acknowledge that the provision of false information in the application is a basis for denial of the application.”

3. (c) Each Part C of Form 2616R “Review of Continued Certification for Transportation Service Providers” (March 2019) submitted by an accompanied transportation service provider agency shall have the following attestation signed and dated by the program coordinator or executive director:

   “I certify that a criminal record check for this individual is completed an on file at the agency.”

4. (d) The provider shall sign and date Part D “Statement of Affirmation” of Form 2616R “Review of Continued Certification for Transportation Service Providers” (March 2019) certifying the following:

   “I have reviewed the Administrative Rule He-C 6343 Certification for Payment Standards for Transportation Service Providers and will adhere to the rules as a certified provider. I authorize the NH Division for Children, Youth and Families (DCYF) to conduct a certification for payment review to determine the program’s compliance with Administrative Rule He-C 6343, Certification for Payment Standards for Transportation Service Providers. I further understand that DCYF has the right to verify information contained in this application.

   The information contained in this application is correct to the best of my knowledge. I acknowledge that the provision of false information in the application is a basis for denial of the application.”

5. (e) Each applicant shall submit the following with Form 2616R “Review of Continued Certification for Transportation Service Providers” (March 2019):

   1. (1) A “State of New Hampshire Alternate W-9” (October 2016);

   2. (2) A Current list of the Board of Directors that shall include the following information of each person:

      1. a. Full Name;
      2. b. Office held;
      3. c. Professional affiliation;
      4. d. Address; and
      5. e. Telephone number;
   3. (3) Automobile and general liability insurance certificates; and
   4. (4) Resume or curriculum vitae for the program coordinator or executive director.
6. (f) Renewal of certification shall be made by filing a signed and dated Form 2616 “Review of Continued Certification for Transportation Service Providers” (March 2019) and shall be based on a review and verification of the provider’s compliance with He-C 6343 and the specific requirements for the certification of Transportation Service provided.
7. (g) Providers who fail to submit a review form within 30 days of receipt shall have their certification revoked in accordance with He-C 6343.24 and be denied payment.
8. (h) Continuance of certification shall be based on a review and verification of the provider’s compliance with service requirements.

9. (i) Review of continued certification compliance shall:

   1. (1) Occur every 5 years from the date of issue for:

      1. a. Accompanied transportation service providers;
      2. b. Public transportation service providers; and
      3. c. Secure transportation service providers; and
   2. (2) Occur every year for private vehicle transportation service providers with the exception of a foster parent licensed through He-C 6347 who is also certified as a private vehicle transportation service provider. Continued certification review shall coincide with renewal of their foster care license.

Source. (See Revision Note at part heading for He-C 6343) #9390, eff 3-1-09, EXPIRED: 3-1-17 New. #12592, INTERIM, eff 7-26-18, EXPIRED: 1-22-19 New. #12750, eff 3-26-19 (formerly He-C 6343.16)