N.Y. Comp. Codes R. & Regs. tit. 14, Appendices, app 102-B
STATEMENT OF COMPLIANCE:
It is understood that the information given herein or attached to this application is correct.
It is also agreed that the applicant will, upon request, submit to the New York State Narcotic Addiction Control Commission such other data as may be needed by the Commission for the purpose of accreditation.
It is also agreed that the applicant will submit the necessary reports as required by the Commission including monthly reports of the addict(s) being treated, including information as to when an addict has been dropped (discharged), disappeared, left or completed the course of treatment.
It is understood that all persons entrusted with the care, treatment, custody and rehabilitation of addicts shall be of good moral character.
It is also understood that the applicant will demonstrate his compliance with Rules and Regulations promulgated by the Commission and applicable federal, State and local regulations and laws.
It is also understood that accreditation for purposes of Section 206 shall not be construed as a specific recommendation of the applicant's treatment program by the Commission.
Signed ____________
Title ____________
Date ____________
CERTIFICATION
This is to certify that the New York State Narcotic Addiction Control Commission has approved/dismissed/denied the foregoing application for accreditation.
Date
Chairman
N.Y. Comp. Codes R. & Regs. tit. 14, Appendices, app 102-B