NCC203976_NOI 31058 Payment Verification_20200914

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/8/2020 11:25:22 AM (NCG01 NOI Submission)
Approve by Morman, Alaina 9/10/2020 1:14:40 PM (Review- Construction NOI 31058)
• The task was assigned to Morman, Alaina by round robin distribution 9/8/2020 11:25 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 10, 2020 5:00
PM 9/8/2020 11:25 AM
Submit by Selkane, Aziza 9/14/2020 9:30:17 AM (Payment Verification for NCC203976)
* Allan Hopkins
• Selkane, Aziza assigned the task to Selkane, Aziza 9/14/2020 9:29 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 22, 2020 5:00 PM
9/10/2020 1:15 PM

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•
V.
• yrnent Verification
NORTH CAROLINA
Envlro me tufQuuftty
Project Name
Pain Care Practice Management
NC Reference No.*
NCG01-2020-3976
Certificate of
NCC203976
Coverage (COC)
No. *
Invoice Date
9/10/2020
Initial Invoice No.
NCC203976-2020
Initial Fee
$ 100.00
Invoice Due Date
10/10/2020
Important: If you change
the choice below to Payment NOT RECEIVED, the application will be rejected, and a COC will
not be issued. This is the ONLY way to reject an eNO1 at this step.
Payment Received* r Payment Received.
r Payment NOT RECEIVED.
Payment Status
PAID
Date Payment
9/14/2020
Received *
(Or, if not received, date rejected for no payrrent)
Method of Payment*
r electronic
r check
r NO PAYMENT RECEIVED
f Other
ePayment
535092650
Transaction
Number*
NOI Tracking No.
31058
Tracking ID referenced upon subrrittal
This is an Express
r No
Review Project
r Yes
Project Tracking ID
NCC-IREDE-2020-Pain Care Practice Management