Last updated: 3/29/2024
Renewal Rehab Supplier Registration
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Description
RENEWAL REHAB SUPPLIER REGISTRATION. This form is used by the State Board of Workers' Compensation in Georgia for the renewal of registration for rehabilitation suppliers. The form requires personal data, including contact information and details about any changes in address or contact information. It also asks about language proficiency, ability to communicate with the deaf in sign language, any history of professional license revocation or disciplinary actions, and criminal history. The applicant must certify the accuracy of the information provided and authorize the State Board of Workers' Compensation to conduct investigations if necessary. There's also an option for catastrophic suppliers to volunteer to serve on a Managed Care & Rehabilitation committee by contacting a specified individual via email. The completed form must be submitted with the required fee by November 30th of each year. Late submissions may incur additional fees or penalties. www.FormsWorkflow.com
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