The reference half: the form, the line, the citation

Government forms register

Every government form, certification line or attestation we have found where a dated public-record receipt is the supporting document — the agency's form, the exact line, the regulation it rests on, what a receipt does and does not show, and the audit finding pattern it answers. The agency is the author of the form and of the record; the receipt is a dated, hashed read of what the record printed. As of 2026-10-07. 33 forms and duties (federal, plus Pennsylvania COSTARS) · 51 states and DC · named on 1105 receipt(s) so far.

Form	The line a receipt supports	Answers finding pattern	Named on
FAR 52.209-5 · FAR 52.204-26 SAM.gov Entity Registration — Representations and Certifications GSA (SAM.gov) / FAR Council	52.209-5(a)(1)(i)(A)–(D): the offeror and its principals are / are not presently debarred, suspended, proposed for debarment or declared ineligible. 52.204-26(c): the offeror has / has not reviewed SAM exclusions for covered telecommunications equipment or services (Section 889).	Suspension & debarment check not documented, or evidence not retained	2 receipt(s)
FAR 52.209-6 Subcontract > $35,000 exclusion check and written notice (contractor's own file; no numbered form) FAR Council	(c) before entering a subcontract exceeding $35,000 the contractor reviews SAM exclusions for the subcontractor; (d) written notice to the contracting officer within 10 days when a subcontractor is excluded.	Suspension & debarment check not documented, or evidence not retained	0 receipt(s)
2 CFR 180.300 · 2 CFR 200.214 · 2 CFR 200.318(h) Lower-tier covered transaction check for federal awards (grants, cooperative agreements, loans) — recipient's procurement file OMB (2 CFR)	180.300: before entering a covered transaction the participant must (a) check SAM Exclusions, (b) collect a certification from the other party, or (c) add a clause. 200.214 applies it to every federal award; 200.318(h) to every procurement.	Suspension & debarment check not documented, or evidence not retained; Payment to an ineligible party; insufficient documentation at invoice	1085 receipt(s)
SF-424B · SF-424D SF-424B Assurances — Non-Construction Programs · SF-424D Assurances — Construction Programs OMB / Grants.gov	The applicant assures it will comply with all applicable requirements of federal laws, executive orders, regulations and policies governing the program — which include 2 CFR 180 and 2 CFR 200.	Suspension & debarment check not documented, or evidence not retained	0 receipt(s)
SF-SAC SF-SAC Data Collection Form for Reporting on Audits of States, Local Governments and Non-Profit Organizations GSA Federal Audit Clearinghouse	Part III findings: reference number, compliance requirement type (I = Procurement and Suspension and Debarment; M = Subrecipient Monitoring), material weakness, repeat. The pass-through entity's duty to obtain the subrecipient's audit sits in 2 CFR 200.332(f) and 200.501.	Subrecipient single audit not obtained; no additional monitoring	0 receipt(s)
HUD-2992 HUD-2992 Certification Regarding Debarment and Suspension (lower tier) HUD	The prospective lower-tier participant certifies it is not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded. Used with CDBG, HOME and ESG subrecipients and contractors; CDBG records in 24 CFR 570.506.	Payment to an ineligible party; insufficient documentation at invoice; Suspension & debarment certification or clause missing from contracts and subawards; Suspension & debarment check not documented, or evidence not retained	0 receipt(s)
AD-1048 AD-1048 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion — Lower Tier Covered Transactions USDA	Same lower-tier certification as HUD-2992, under USDA's adoption of 2 CFR 180 (2 CFR 417).	Suspension & debarment certification or clause missing from contracts and subawards; Suspension & debarment check not documented, or evidence not retained	0 receipt(s)
FHWA-1273 FHWA-1273 Required Contract Provisions, Federal-Aid Construction Contracts — §XI Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion; §IV Davis-Bacon FHWA (US DOT)	§XI.1 first-tier participants and §XI.2 lower-tier participants certify as to debarment and suspension (2 CFR 1200 / 180); §IV requires weekly certified payrolls from every contractor and subcontractor.	Suspension & debarment certification or clause missing from contracts and subawards; Davis-Bacon certified payrolls not obtained or not reviewed; Suspension & debarment check not documented, or evidence not retained	0 receipt(s)
WH-347 WH-347 Payroll (for contractors' optional use) and Statement of Compliance — Davis-Bacon certified payroll DOL Wage and Hour Division	Statement of Compliance signed weekly by the contractor or subcontractor (29 CFR 5.5(a)(3)(ii)); 29 CFR 5.12 ineligibility (debarment) for violations.	Davis-Bacon certified payrolls not obtained or not reviewed	0 receipt(s)
SF-1413 SF-1413 Statement and Acknowledgment (subcontract under a construction contract) GSA	Part II: the subcontractor acknowledges the labor standards clauses (FAR 52.222-11); the prime files one per subcontract.	Suspension & debarment certification or clause missing from contracts and subawards; Davis-Bacon certified payrolls not obtained or not reviewed; Suspension & debarment check not documented, or evidence not retained	0 receipt(s)
CMS-855A · 855B · 855I · 855S CMS-855A / 855B / 855I / 855S Medicare Enrollment Applications — Section 3 Final Adverse Legal Actions CMS	Section 3 asks the applicant to list exclusions, debarments, revocations and license suspensions; 42 CFR 424.516 requires reporting changes within 30 days; 42 CFR 424.535 lists revocation grounds.	Provider exclusion screening not performed at enrollment or monthly	0 receipt(s)
42 CFR 455.104 · 455.105 · 455.106 · 455.436 State Medicaid provider enrollment application and disclosures (ownership and control, business transactions, criminal convictions) — one form per state Each state Medicaid agency (CMS rule)	455.436(b)–(c): the state agency checks the LEIE and SAM exclusions at enrollment, re-enrollment and monthly thereafter; 455.104–106: the provider discloses owners, managing employees and convictions on the state's form.	Provider exclusion screening not performed at enrollment or monthly	0 receipt(s)
42 CFR 422.503(b)(4)(vi)(F) · 423.504(b)(4)(vi)(F) Medicare Advantage / Part D compliance program — first-tier, downstream and related entity (FDR) exclusion screening attestation (HPMS) CMS	The sponsor's compliance program must screen employees, governing body and FDRs against the OIG LEIE and SAM before hire or contract and monthly thereafter; attested annually in HPMS.	Provider exclusion screening not performed at enrollment or monthly	0 receipt(s)
FAR 52.204-7 SAM registration requirement — active SAM registration at offer and award FAR Council	(b)(1): an offeror is required to be registered in SAM when submitting an offer and to continue to be registered until time of award, during performance and through final payment.	Suspension & debarment check not documented, or evidence not retained	0 receipt(s)
FAR 52.209-7 · FAR 52.209-9 Information Regarding Responsibility Matters (FAPIIS) — offeror representation and public FAPIIS record FAR Council / GSA (SAM.gov FAPIIS)	52.209-7(b)–(c): the offeror represents whether it has active federal contracts and grants over $10 million and whether, within five years, it has had criminal, civil or administrative proceedings concluded against it — entered in FAPIIS. 52.209-9: the contractor updates the public FAPIIS record semi-annually.	Suspension & debarment check not documented, or evidence not retained	0 receipt(s)
FAR 52.204-10 · FFATA Reporting Executive Compensation and First-Tier Subcontract Awards (FSRS / SAM.gov) FAR Council / GSA	(d): the contractor reports each first-tier subcontract of $30,000 or more, with the subcontractor's UEI; the report is published through USAspending.	Subrecipient single audit not obtained; no additional monitoring	0 receipt(s)
FAR 52.219-1 Small Business Program Representations — size and socio-economic status as self-certified in SAM FAR Council / SBA	(c): the offeror represents that it is / is not a small business concern under the NAICS code assigned, and its socio-economic status — self-certified in SAM.		0 receipt(s)
SF-LLL SF-LLL Disclosure of Lobbying Activities OMB / Grants.gov	Items 10a–10b: the lobbying registrant and individuals performing services; filed when non-federal funds were used to lobby in connection with a federal award (31 U.S.C. 1352).		0 receipt(s)
HUD-2880 HUD-2880 Applicant/Recipient Disclosure/Update Report — other government assistance and interested parties HUD	Part II: other government assistance expected for the project; Part III: interested parties and their financial interest (24 CFR part 4, subpart A; 42 U.S.C. 3545).		0 receipt(s)
HUD-4010 HUD-4010 Federal Labor Standards Provisions — Davis-Bacon on HUD-assisted construction HUD Office of Labor Standards	A.3(ii) weekly certified payrolls; A.11 subcontracts (the contractor is responsible for compliance by any subcontractor); 29 CFR 5.12 ineligible contractors.	Davis-Bacon certified payrolls not obtained or not reviewed; Suspension & debarment certification or clause missing from contracts and subawards	0 receipt(s)
EPA 5700-49 EPA Form 5700-49 Certification Regarding Debarment, Suspension and Other Responsibility Matters EPA Office of Grants and Debarment	The applicant or lower-tier participant certifies as to debarment, suspension, proposed debarment and other responsibility matters under EPA's adoption of 2 CFR 180 (2 CFR 1532).	Suspension & debarment certification or clause missing from contracts and subawards; Suspension & debarment check not documented, or evidence not retained	0 receipt(s)
FTA C&A (annual) FTA Annual Certifications and Assurances (TrAMS) — Category 01 includes suspension and debarment; Category 05 Davis-Bacon Federal Transit Administration (US DOT)	Category 01 'Certifications and Assurances Required of Every Applicant' includes the applicant's assurance that it will comply with 2 CFR 1200 / 2 CFR 180 on suspension and debarment for every third-party contract and subrecipient.	Suspension & debarment check not documented, or evidence not retained; Subrecipient single audit not obtained; no additional monitoring	0 receipt(s)
CBP Form 28 CBP Form 28 Request for Information — importer response on UFLPA / forced-labor applicability U.S. Customs and Border Protection	The importer answers CBP's request with supply-chain documentation; under the UFLPA (Pub. L. 117-78 §3) goods from a UFLPA Entity List party are presumed prohibited unless rebutted.		0 receipt(s)
42 CFR 438.608(b)–(c) Medicaid managed care plan — network provider screening, enrollment and ownership disclosure attestation to the state CMS / each state Medicaid agency	438.608(b): network providers must be screened and enrolled by the state; (c): the MCO discloses ownership and control and reports excluded or terminated providers; 438.610 prohibits relationships with excluded persons.	Provider exclusion screening not performed at enrollment or monthly	0 receipt(s)
SF-328 SF-328 Certificate Pertaining to Foreign Interests (facility clearance — DCSA) DCSA (Department of Defense)	Questions 1–10: foreign ownership of 5% or more, foreign directors or officers, foreign contracts and indebtedness, as the company answers them.		0 receipt(s)
2 CFR 200.332 Subrecipient risk assessment and monitoring (pass-through entity's own file; no numbered form) OMB (2 CFR 200)	200.332(b): evaluate each subrecipient's risk of noncompliance — including prior audit results (200.332(b)(1)); 200.332(d): monitor, including review of reports and follow-up on audit findings; 200.332(f): verify every subrecipient expending $1,000,000 or more is audited under Subpart F.	Subrecipient single audit not obtained; no additional monitoring	1 receipt(s)
CMS-855 §5–6 · 42 CFR 455.104, 455.436 CMS-855A/B/I Section 5 and 6 — ownership, managing employees, and the exclusion screen of each CMS / each state Medicaid agency	455.104(b): disclose each person with 5% or more ownership or control and each managing employee; 455.436(b)–(c): check LEIE and SAM for each disclosed person at enrollment, re-enrollment and monthly; 455.436(a) and 42 CFR 1001.1901: no payment for items or services furnished, ordered or prescribed by an excluded person.		0 receipt(s)
OSHA 300A · 29 CFR 1904 OSHA Form 300A — Summary of Work-Related Injuries and Illnesses OSHA (US DOL)	1904.32: complete and post the 300A summary from February 1 to April 30; 1904.41: establishments of 250+ employees (and 20–249 in designated industries) submit 300A data electronically to OSHA's Injury Tracking Application by March 2.		0 receipt(s)
FAR 52.209-5 · FAR 52.209-11 Offeror certifications — debarment status and felony/tax-delinquency representation FAR Council	52.209-5(a)(1)(i)(A): the offeror and/or its principals are / are not presently debarred, suspended, proposed for debarment or declared ineligible; 52.209-11(b): the offeror is / is not a corporation with an unpaid federal tax liability finally assessed, or convicted of a felony under federal law within 24 months.	Suspension & debarment check not documented, or evidence not retained	17 receipt(s)
FAR 52.222-50 · 2 CFR 175 Combating Trafficking in Persons clause; award-term anti-trafficking provision FAR Council / OMB (2 CFR 175)	52.222-50(c)–(d): the contractor shall not engage in, and shall notify the agency of, prohibited trafficking activities, and shall flow the clause down; 2 CFR 175.15: the award term applies to the recipient and every subrecipient; 22 U.S.C. 7104(g): termination for violation.		0 receipt(s)
49 CFR Part 26, Appendix F · 49 CFR 26.81 DBE Uniform Certification Application and the state UCP directory US DOT / each state Unified Certification Program	26.81(g): each UCP maintains a unified directory of certified DBEs, available to the public and updated; 26.55: DBE participation counts only for work performed by a certified DBE; 26.37(a): the recipient monitors that DBE work is actually performed by the DBE.		0 receipt(s)
IRS 990 · 26 U.S.C. 6033 IRS Form 990 Return of Organization Exempt From Income Tax (Schedules L and O; Part VII) IRS Tax Exempt and Government Entities	Part IV line 28 and Schedule L: transactions with interested persons; Part VII: officers, directors, key employees and compensation; Part VI line 12: conflict-of-interest policy — as filed. 26 U.S.C. 6104(b): the return is open to public inspection.		0 receipt(s)
62 Pa.C.S. § 1902 · COSTARS contract number COSTARS cooperative purchasing — supplier contract in force at time of purchase (PA local public procurement units) PA Department of General Services (COSTARS)	62 Pa.C.S. § 1902(a): a local public procurement unit may purchase from a supplier under a Commonwealth cooperative contract without separate bidding; the purchase file shows the COSTARS contract number and that the supplier was a COSTARS-contracted supplier on the purchase date.		0 receipt(s)

Forms → findings crosswalk

Finding patterns from single audits filed at the Federal Audit Clearinghouse, cited by report id; the auditor's words, not ours.

Suspension & debarment check not documented, or evidence not retained

I — Procurement and Suspension and Debarment (2 CFR 180.300, 200.214, 200.318(h))

Hamilton Health Center, Inc. (Harrisburg, PA) — finding 2025-003, FAC report 2025-03-GSAFAC-0000391916, FY end 2025-03-31: “failed to verify the suspension and debarment status of vendors prior to awarding contracts exceeding the $25,000 threshold. Documentation of verification through SAM.gov or equivalent methods was not available.”
UPMC (PA) — finding 2023-003, FAC report 2023-12-GSAFAC-0000428922, FY end 2023-12-31 · material weakness: “did not retain sufficient evidence to support the design and operation of internal controls over … Procurement and Suspension and Debarment”
UPMC (PA) — finding 2024-004, FAC report 2025-12-GSAFAC-0000428918, FY end 2024-12-31 · material weakness · repeat: “repeat of 2023-003 on the same program”

Record that answers it: One SAM.gov exclusions receipt per vendor or subcontractor, dated at or before award (> $25,000 under 2 CFR; > $35,000 under FAR 52.209-6), kept with the procurement file.

Downstream, nationwide: type I — 2024: 6897, 2025: 7479 finding rows at the FAC. Number of findings rows the Federal Audit Clearinghouse prints for each compliance requirement type and audit year, nationwide. A null means FAC did not answer for that cell. Counts are of findings as filed by auditors — not of organizations, and not a measure of anyone.

2 CFR 180.300 · 2 CFR 200.214 · 2 CFR 200.318(h)FAR 52.209-5 · FAR 52.204-26 FAR 52.209-6 SF-424B · SF-424D HUD-2992 AD-1048 FHWA-1273

Subrecipient single audit not obtained; no additional monitoring

M — Subrecipient Monitoring (2 CFR 200.332(f), 200.501)

County of Dauphin (PA) — finding 2019-001, FAC report 2019-12-CENSUS-0000166825, FY end 2019-12-31 · material weakness: “the County did not obtain the required audit report for the program subrecipient or perform any additional monitoring procedures.”
Commonwealth of Pennsylvania (PennDOT, Highway Planning & Construction Cluster) — finding 2020-014, FAC report 2020-06-CENSUS-0000166791, FY end 2020-06-30: “monitoring of HPC Cluster subrecipient local projects … was not adequate”

Record that answers it: A Federal Audit Clearinghouse receipt per subrecipient per year: whether an SF-SAC is on file, the fiscal year end, and the finding reference numbers printed there.

Downstream, nationwide: type M — 2024: 4277, 2025: 8550 finding rows at the FAC. Number of findings rows the Federal Audit Clearinghouse prints for each compliance requirement type and audit year, nationwide. A null means FAC did not answer for that cell. Counts are of findings as filed by auditors — not of organizations, and not a measure of anyone.

SF-SAC

Payment to an ineligible party; insufficient documentation at invoice

A/B — Activities Allowed, Allowable Costs; HUD CDBG records (24 CFR 570.506)

City of Harrisburg (PA) — finding 2019-008, FAC report 2019-12-CENSUS-0000186099, FY end 2019-12-31 · material weakness · repeat: “did not have a process in place to review expenditures for allowability before the invoices were paid … payment to an ineligible party … insufficient documentation”

Record that answers it: A payment-time read of the payee's printed name (SAM exclusions, OIG LEIE, OFAC, state list) dated before the disbursement, filed with the invoice. It answers the 'ineligible party / documentation' element only — allowability is accounting.

Downstream, nationwide: type A — 2024: 1137, 2025: 1925 · type B — 2024: 6430, 2025: 3649 finding rows at the FAC. Number of findings rows the Federal Audit Clearinghouse prints for each compliance requirement type and audit year, nationwide. A null means FAC did not answer for that cell. Counts are of findings as filed by auditors — not of organizations, and not a measure of anyone.

HUD-2992 2 CFR 180.300 · 2 CFR 200.214 · 2 CFR 200.318(h)

Suspension & debarment certification or clause missing from contracts and subawards

I — Procurement and Suspension and Debarment; 2 CFR 200.332(a) award terms

No finding of this pattern cited yet from the audits we have read; the pattern is named from the regulation.

Record that answers it: The form itself (HUD-2992, AD-1048, FHWA-1273 §XI) plus the dated SAM read on the day it was signed. Neither replaces the other.

HUD-2992 AD-1048 FHWA-1273 SF-1413

Davis-Bacon certified payrolls not obtained or not reviewed

Davis-Bacon / Wage Rate Requirements (29 CFR 5.5(a)(3)(ii), 5.12)

No finding of this pattern cited yet from the audits we have read; the pattern is named from the regulation.

Record that answers it: DOL Wage & Hour enforcement rows under the contractor's printed name (Davis-Bacon, SCA, CWHSSA counts; back wages agreed; findings period), dated; the WHD debarment list is printed 'not read' with the official link because DOL refuses automated reads.

WH-347 SF-1413 FHWA-1273

Provider exclusion screening not performed at enrollment or monthly

Medicaid provider enrollment and screening (42 CFR 455.436; 42 CFR 1001.1901)

No finding of this pattern cited yet from the audits we have read; the pattern is named from the regulation.

Record that answers it: A dated OIG LEIE + SAM + state-list receipt per provider at enrollment and a monthly series (Receipt Watch), with 'did not answer' printed when a source was silent.

CMS-855A · 855B · 855I · 855S 42 CFR 455.104 · 455.105 · 455.106 · 455.436 42 CFR 422.503(b)(4)(vi)(F) · 423.504(b)(4)(vi)(F)

State by state

State by state: the Medicaid agency, its exclusion list and how this platform reads it, and the state forms where a dated receipt is the supporting record. Where we hold no official link we say so.

Alabama — Alabama Medicaid Agency

Exclusion list: Suspended / Sanctioned Providers · medicaid.alabama.gov/content/8.0_Fraud/8.7_Suspended_Providers.aspx

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

Alabama Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure.

Alabama procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Alaska — Alaska Department of Health, Program Integrity

Exclusion list: Excluded Provider List · health.alaska.gov/Commissioner/Pages/ProgramIntegrity/default.aspx

Published as a PDF — this platform holds a dated copy and prints rows under the exact name.

Alaska Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Alaska procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Arizona — Arizona AHCCCS

Exclusion list: Provider Suspensions and Terminations · www.azahcccs.gov/Fraud/Providers/actions.html

Published as a PDF — this platform holds a dated copy and prints rows under the exact name.

Arizona Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Arizona procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Arkansas — Arkansas DHS

Exclusion list: Excluded Provider List · dhs.arkansas.gov/dhs/portal/Exclusions/PublicSearch/

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Arkansas Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Arkansas procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

California — California DHCS, Medi-Cal

Exclusion list: Suspended and Ineligible Provider List · mcweb.apps.prd.cammis.medi-cal.ca.gov/references/sandi

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

California Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

California procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Colorado — Colorado Department of Health Care Policy & Financing

Exclusion list: Terminated Provider List · hcpf.colorado.gov/provider-termination

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

Colorado Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Colorado procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Connecticut — Connecticut Department of Social Services

Exclusion list: Administrative Actions List

Official page not yet located by us — start at the state Medicaid agency's provider enrollment page.

Connecticut Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Connecticut procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Delaware — Delaware DHSS, Division of Medicaid and Medical Assistance

Exclusion list: Sanctioned Providers · medicaid.dhss.delaware.gov/provider/Home/ProgramIntegrityLanding/tabid/2102/Default.aspx

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Delaware Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Delaware procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

District of Columbia — DC Department of Health Care Finance

Exclusion list: Excluded Parties List

Official page not yet located by us — start at the state Medicaid agency's provider enrollment page.

District of Columbia Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

District of Columbia procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Florida — Florida Agency for Health Care Administration

Exclusion list: Sanctioned Providers · apps.ahca.myflorida.com/dm_web/

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Florida Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Florida procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Georgia — Georgia Department of Community Health, Office of Inspector General

Exclusion list: List of Excluded Individuals and Entities · dch.georgia.gov/office-inspector-general/georgia-oig-exclusions-list

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

Georgia Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Georgia procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Hawaii — Hawaii Med-QUEST Division

Exclusion list: Provider Exclusion / Reinstatement List · medquest.hawaii.gov/en/plans-providers/provider-exclusion-reinstatement-list.html

Published as a PDF — this platform holds a dated copy and prints rows under the exact name.

Hawaii Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Hawaii procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Idaho — Idaho Department of Health and Welfare

Exclusion list: Medicaid Provider Exclusion List

Official page not yet located by us — start at the state Medicaid agency's provider enrollment page.

Idaho Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Idaho procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Illinois — Illinois HFS Office of Inspector General

Exclusion list: Provider Sanctions

Official page not yet located by us — start at the state Medicaid agency's provider enrollment page.

Illinois Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Illinois procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Indiana — Indiana FSSA, Office of Medicaid Policy and Planning

Exclusion list: Terminated Providers · www.in.gov/fssa/ompp/provider-information/termination-of-provider-participation-in-medicaid-and-chip

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

Indiana Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Indiana procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Iowa — Iowa HHS, Iowa Medicaid

Exclusion list: Excluded Individuals and Entities (Sanctions List) · hhs.iowa.gov/programs/welcome-iowa-medicaid/provider-services/excluded-individuals-and-entities

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

Iowa Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Iowa procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Kansas — Kansas Department of Health and Environment (KMAP)

Exclusion list: Termination List · www.kdhe.ks.gov/172/Medicaid

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

Kansas Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Kansas procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Kentucky — Kentucky Department for Medicaid Services

Exclusion list: Terminated and Excluded Providers · www.chfs.ky.gov/agencies/dms/dpi/pe/Pages/terminated.aspx

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

Kentucky Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Kentucky procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Louisiana — Louisiana Department of Health

Exclusion list: Adverse Actions List · adverseactions.ldh.la.gov/SelSearch/

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Louisiana Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Louisiana procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Maine — MaineCare Services

Exclusion list: Excluded Providers · mainecare.maine.gov/mhpviewer.aspx?FID=MEEX

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Maine Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Maine procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Maryland — Maryland Department of Health, Medicaid

Exclusion list: Sanctioned Provider List · health.maryland.gov/mmcp/provider/Pages/sanctioned_list.aspx

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

Maryland Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Maryland procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Massachusetts — MassHealth

Exclusion list: Suspended or Excluded MassHealth Providers · www.mass.gov/info-details/learn-about-suspended-or-excluded-masshealth-providers

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Massachusetts Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Massachusetts procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Michigan — Michigan MDHHS

Exclusion list: List of Sanctioned Providers · www.michigan.gov/mdhhs/doing-business/providers/providers/billingreimbursement/list-of-sanctioned-providers

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Michigan Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Michigan procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Minnesota — Minnesota DHS

Exclusion list: Excluded Providers · www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS-295094

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Minnesota Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Minnesota procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Mississippi — Mississippi Division of Medicaid

Exclusion list: Sanctioned Providers List · medicaid.ms.gov/providers/provider-terminations/

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

Mississippi Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Mississippi procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Missouri — Missouri Medicaid Audit and Compliance

Exclusion list: Sanction List · mmac.mo.gov/providers/provider-sanctions/

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

Missouri Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Missouri procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Montana — Montana DPHHS

Exclusion list: Excluded or Terminated Providers · dphhs.mt.gov/montanahealthcareprograms/terminatedexcludedproviders

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

Montana Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Montana procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Nebraska — Nebraska DHHS

Exclusion list: Medicaid Excluded Providers · dhhs.ne.gov/Pages/Program-Integrity-Sanctioned-Providers.aspx

Published as a PDF — this platform holds a dated copy and prints rows under the exact name.

Nebraska Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Nebraska procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Nevada — Nevada DHCFP

Exclusion list: Exclusions / Sanctions · dhcfp.nv.gov/Providers/PI/PSExclusions/

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Nevada Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Nevada procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

New Hampshire — New Hampshire DHHS

Exclusion list: Exclusion and Sanction List · www.dhhs.nh.gov/programs-services/medicaid/medicaid-provider-relations

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

New Hampshire Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

New Hampshire procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

New Jersey — New Jersey Office of the State Comptroller, Medicaid Fraud Division

Exclusion list: Ineligible Medicaid Providers · www.nj.gov/comptroller/about/work/medicaid/ineligibleprovider.shtml

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

New Jersey Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

New Jersey procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

New Mexico —

Exclusion list: none located

No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM.

New Mexico Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

New Mexico procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

New York — New York State Office of the Medicaid Inspector General

Exclusion list: NYS Medicaid Exclusion List · omig.ny.gov/medicaid-fraud/medicaid-exclusions

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

New York Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

New York procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

North Carolina — NC Medicaid, Division of Health Benefits

Exclusion list: State Excluded Provider List · medicaid.ncdhhs.gov/providers/excluded-providers

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

North Carolina Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

North Carolina procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

North Dakota — North Dakota HHS

Exclusion list: Terminated Provider List · www.hhs.nd.gov/healthcare/medicaid/provider/compliance/fraud-and-abuse

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

North Dakota Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

North Dakota procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Ohio — Ohio Department of Medicaid

Exclusion list: Provider Exclusion and Suspension List · medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers/enrollment-and-support/provider-enrollment/provider-exclusion-and-suspension-list

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

Ohio Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Ohio procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

OhioBuys supplier registration (Ohio DAS)

ORC 125; ORC 9.24 (unresolved findings for recovery — Auditor of State)

ohiobuys.ohio.gov/

Registration page held. Ohio's debarred-vendor list and ORC 9.24 unresolved-findings list are published by DAS and the Auditor of State; we hold no direct link.

Oklahoma —

Exclusion list: none located

No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM.

Oklahoma Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Oklahoma procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Oregon — Oregon Health Authority, Program Integrity Audit Unit

Exclusion list: Convictions / Exclusions · www.oregon.gov/oha/FOD/PIAU/Pages/Convictions.aspx

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Oregon Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Oregon procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Pennsylvania — Pennsylvania DHS

Exclusion list: Medicheck List · www.pa.gov/agencies/dhs/report-fraud/medicheck-list

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Pennsylvania Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Pennsylvania procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

PA Supplier Portal registration (Commonwealth vendor record; DGS Bureau of Procurement)

62 Pa.C.S. (Procurement Code); Commonwealth contractor responsibility program

pasupplierportal.state.pa.us/

Registration page held. The Commonwealth's debarment list and non-collusion affidavit form are published by DGS; we hold no direct link — locate on pa.gov/agencies/dgs.

PennDOT ECMS contractor prequalification and FHWA-1273 on federal-aid projects

67 Pa. Code ch. 457; 23 CFR 635.117

ECMS is a login system (ecms.penndot.gov) — not read; FHWA-1273 above applies to every federal-aid contract.

Rhode Island —

Exclusion list: none located

No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM.

Rhode Island Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Rhode Island procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

South Carolina — South Carolina Department of Health and Human Services

Exclusion list: Excluded / Terminated Providers · www.scdhhs.gov/fraud

Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served).

South Carolina Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

South Carolina procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

South Dakota —

Exclusion list: none located

No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM.

South Dakota Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

South Dakota procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Tennessee — TennCare, Program Integrity

Exclusion list: Terminated Providers · www.tn.gov/tenncare/fraud-and-abuse/program-integrity.html

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Tennessee Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Tennessee procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Texas — Texas HHSC Office of Inspector General

Exclusion list: Exclusions Database File · oig.hhsc.state.tx.us/oigportal2/Exclusions/ctl/DOW/mid/384

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Texas Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Texas procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Utah —

Exclusion list: none located

No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM.

Utah Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Utah procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Vermont — Vermont Department of Vermont Health Access

Exclusion list: Excluded Providers

Official page not yet located by us — start at the state Medicaid agency's provider enrollment page.

Vermont Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Vermont procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Virginia —

Exclusion list: none located

No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM.

Virginia Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Virginia procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Washington — Washington Health Care Authority

Exclusion list: Provider Termination and Exclusion List · www.hca.wa.gov/billers-providers-partners/become-apple-health-provider/provider-termination-and-exclusion-list

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Washington Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Washington procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

West Virginia — West Virginia Bureau for Medical Services

Exclusion list: Provider Exclusions and Terminations · www.wvmmis.com/SitePages/Medicaid%20Provider%20SanctionedExclusion

Published as a PDF — this platform holds a dated copy and prints rows under the exact name.

West Virginia Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

West Virginia procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Wisconsin —

Exclusion list: none located

No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM.

Wisconsin Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Wisconsin procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

Wyoming — Wyoming Department of Health, Medicaid

Exclusion list: Provider Exclusion List · health.wyo.gov/healthcarefin/medicaid/

Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages.

Wyoming Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions

42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)

Wyoming procurement suspension/debarment certification or non-collusion affidavit

State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state

Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification.

On a receipt. Name the form line(s) a receipt is filed behind with ?forms=<id,id> on https://alphacovenantholdings.com/api/public-record/screening (and /html), the partner receipt body field 'forms', or a 'forms' column in a roster CSV. The block is printed and hashed with the body. Run a receipt and name the form. Your record by year. Sector Maps — which of these apply to your kind of organisation.

A read receipt, not a payment receipt. Portal transaction records, bank confirmations, filing acknowledgements, ERP confirmations and paper vouchers prove that money moved or something was submitted. A receipt here proves only what an official source printed for a name on a dated read — the document the line's test asks for before the payment. It does not substantiate an expense, settle a payment or prove a filing.

Forms we do not serve, and why

USCIS Form I-9 / E-Verify case results — employment eligibility records held by the employer and USCIS; not public. Nothing a receipt can read stands behind the form. · official page
WH-347 certified payroll — accuracy of hours and rates — the payroll itself is the contractor's record. A receipt reads only the public enforcement record around it (DOL WHD cases, Davis-Bacon debarments in SAM); the form WH-347 entry above supports that line only. · official page
State professional and business licenses (beyond Pennsylvania) — each state board publishes separately and most are not machine-readable; the Pennsylvania layer (PALS) is served by the state product, other states print as 'not read'. · official page
SAM Reps & Certs — ownership / FOCI representations (FAR 52.204-17, 52.204-20) — self-reported by the registrant; a receipt prints the entry as filed and never makes a FOCI, affiliation or control finding. · official page
SF-330 Architect-Engineer Qualifications — qualifications and past-performance statements written by the firm; no public record we read prints them. The agency's instructions are on the form. · official page
DD Form 254 Contract Security Classification Specification — issued by the government to the contractor, not filed by the contractor; classification guidance, not a public record. · official page
IRS Form W-9 Request for Taxpayer Identification Number and Certification — a tax identity certification between payer and payee; the IRS publishes no public record behind it. The IRS instructions are on the form. · official page
SBA Form 1623 / SBA size-protest and certification filings — size is an SBA determination on average annual receipts including affiliates; no public record we read prints it. · official page
FinCEN Beneficial Ownership Information Report (BOIR) — not public; reporting requirement for domestic companies was removed in 2025. · official page
FMCSA MCS-150 / Unified Registration — carrier registration record, served by the Carrier product under a DOT number, not by a screening receipt; registrant contacts are never used for outreach (SOP-13). · official page
OIG Self-Disclosure Protocol submission — a protocol, not a form; counsel decides. The dated LEIE check history can be attached but the receipt is not the submission. · official page
State Secretary of State good-standing certificates — issued by the state; a receipt prints the registry row where a state exposes one, never a 'good standing' statement.

Not legal advice, not a compliance determination, not a statement that any filer's certification is true or false. Form numbers and line numbers are as published on the date noted and may be renumbered by their agencies; the official page controls. Audit findings quoted are the auditor's words as filed at the Federal Audit Clearinghouse, cited by report id; they describe a documentation gap, not a conclusion about any party. · Where to get the record · Rules · Corrections

Forms Desk

Ask what the rule requires. Every sentence cites or the desk says the sources don't answer.

Answers come only from the Forms Register, the procedure steps as the regulation writes them, the eCFR text and the customer's own filing. The desk never says whether a duty was met, whether a cost is allowable, or what an auditor will conclude.

Government forms register

Which forms do you file? Two questions.

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Forms we do not serve, and why

Ask what the rule requires. Every sentence cites or the desk says the sources don't answer.