• DP-156, Nursing Facility Quality Assessment Return (Call 271-2191 w/questions about this form)
• DP-156-ACH, Nursing Facility Quality Assessment Authorization Agreement for Pre-Authorized Payments
  (ACH Debits (Call 271-2191 w/questions about this form)
• Health & Human Services Calculation Worksheet (Call 271-4341 w/questions about this form)
• NFQA Timeline

All quarterly due dates:

• Period: October 1 to December 31 due January 10
• Period: January 1 to March 31 due April 10
• Period: April 1 to June 30 due July 10
• Period: July 1 to September 30 due October 10

Questions regarding the calculation of your Net Patient Services Revenue should be directed to NH Health & Human Services, Bureau of Elderly & Adult Services, Rate Setting & Audit Unit at (603) 271-4341.

Questions regarding the filing of completed returns or ACH Debit forms may be directed to NH Department of Revenue Customer Service at (603) 271-2191.

Adobe Acrobat Reader "plug in" must be installed on your computer to access any form on this web site. To order forms by telephone, call (603) 271-2192.  Visit the Adobe website to access free ADOBE software. Forms access works best when using the most recent Adobe Acrobat Reader version available.  Some Internet Explorer users may experience difficulty viewing forms in their browser, and may have issues with cached data.  If this occurs, you may upgrade your browser to the most recent Internet Explorer version, view the file in Netscape Navigator or visit Adobe's website to access Adobe's instructions on correcting the problem.