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Form 472
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Form 472
Billed Entity Applicant Reimbursement
("BEAR")
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Tip 6: Applicants can chose check or credit for reimbursements.
* Reimbursements for retroactive discounts can be received as a one-time payment or as a credit against future services. While most vendors have a preference of check or credit, the SLD has indicated that the ultimate choice should be made by the individual applicants. There is no field on the Form 472 to indicate the applicant's choice so an applicant with a strong preference should contact its vendor directly.
Tip 7: A computerized version of Form 472 is available on the web.
* A copy of Form 472 can be downloaded and printed from the SLD web site, but cannot be first filled in online.
* An online PDF formatted version is available on our Forms Rack. Using the free Acrobat Reader, the form can be opened, data can be filled in, and the completed form can be printed. To be able to save data entered in the PDF version of Form 472, which would be useful for applicants expecting to file multiple forms, its is necessary to purchase Acrobat Acrobat.
Tip 8: Bill Collection for BEAR Form Submission
There are two basic principles to keep in mind when collecting bills to prepare a BEAR form.
* Only include bills for services received and paid in full during the effective discount period. The starting date should be no earlier than the Effective Date of Discount shown on Funding Commitment Decisions ("FCD") Letter. The end date for reimbursements should be no later than the end of the funding year or any earlier Contract Expiration Date shown on the FCD letter.
* If the bills include charges for both eligible and ineligible services, the two amounts must be separated and only the eligible portion can be claimed in the BEAR form. Separation, if required, should be on the same basis as was done when preparing the original Form 471. For local telephone service, exclude any charges for pay phones, extra directory listings, and long distance charges from other carriers.
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