titled “Form DP-153 ACH, Medicaid Enhancement Tax Authorization

Agreement for Electronic Payments.”

The prior filings affecting Rev 2501.17 included the following documents:

#10484, effective 12-5-13 (from Rev 2501.15)

#12907, effective 10-23-19

The prior filings affecting Rev 2502.02 included the following documents:

#6639, eff 11-27-97, EXPIRED: 11-27-05

#8495, eff 11-30-05

#10484, effective 12-5-13

#12907, effective 10-23-19

The prior filings affecting Rev 2504.03 included the following documents:

#10484, effective 12-5-13 (from Rev 2505.03)

#12907, effective 10-23-19

The prior filings affecting Rev 2504.04 included the following documents:

#10484, effective 12-5-13 (from Rev 2505.04)

#12907, effective 10-23-19

The prior filings affecting Rev 2504.05 included the following documents:

#10484, effective 12-5-13

#12907, effective 10-23-19

The prior filings affecting Rev 2505.03 and Rev 2505.05 included the following documents:

Source. #8495, eff 11-30-05 #10484, effective 12-5-13 #12907, effective 10-23-19