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Public Goods Pool Reporting Forms and Instructions

1% Statewide Assessment Reporting Forms and Instructions

Schedule of Statewide Payment and Filing Due Dates
Instructions for Completing Report Forms (PDF, 25KB)
NOTE: Updated instructions for reporting periods beginning April 1, 2009 are located at: http://www.health.state.ny.us/nysdoh/hcra/rfmenu.htm
Report Forms - The Reporting Forms are only available in PDF. If you need these documents in an alternate format, please call (518) 474-1673.
- Remittance Advice Forms
  - 2005 (PDF, 41KB, 1pg.)
  - 2004 (PDF, 41KB, 1pg.)
  - 2003 (PDF, 18KB, 1pg.)
  - 2002 (PDF, 19KB, 1pg.)
  - 2001 (PDF, 18KB, 1pg.)
  - 2000 (PDF, 24KB, 1pg.)
  - 1999 (PDF, 17KB, 1pg.)
  - 1998 (PDF, 16KB, 1pg.)
  - 1997 (PDF, 14KB, 1pg.)
Certification Form (PDF, 30KB, 1pg.)