Antabuse buy

Short-term health plans in Missouri Short-term plans duration in MissouriUntil October 2018, federal rules limited short-term health insurance plan duration to no more than three months, and prohibited renewals antabuse buy. But the Trump administration changed the rules to allow much longer short-term plans, unless states have their own restrictions.Missouri regulations limit short-term healthcare plans to no more than six months in duration antabuse buy. But the state does not limit the renewability of short-term plans.The Trump Administration’s new rules for short-term plans are clear in noting that states may continue to impose tighter regulations than the new federal rules.

So short-term health insurance plans in Missouri are limited to a maximum initial term of six months, despite the antabuse buy fact that the federal government would allow the plans to have initial terms of up to 364 days.However, the Missouri Department of Insurance confirmed that the state does not limit renewals, and defaults to the federal rules for the total duration (including renewal periods) of a short-term plan. So an insurer is within the bounds of the law to offer a plan that could be renewed for up to 36 months (the limit in the federal rules), as long as each term isn’t more than six months. There are several insurance companies that take this approach in Missouri, offering enrollees up to 36 months of coverage with one application.Missouri’s short-term health insurance regulationsLawmakers in Missouri considered HB1685 in 2018, which would have defined short-term healthcare coverage as a policy with a antabuse buy duration of less than one year.

The House passed the measure, but it didn’t reach a full vote on the Senate floor before the session adjourned.Missouri insurance statutes generally exclude short-term plans from laws mandating specific benefits. The state’s filing guidance for short-term plans notes that any plans with terms antabuse buy in excess of six months will be subject to all state mandates. Which insurers sell short-term plans in Missouri?.

As of late 2020, there were at least eight insurance companies that provide short-term health insurance policies in Missouri:Blue KC (Blue Cross Blue Shield of Kansas City)Companion LifeCox Health SystemsEverest ReinsuranceIndependence American Insurance CompanyNational General (National Health Insurance Company)UnitedHealthcare (Golden Rule)United Security Health and CasualtyThe benefits and coverage specifics vary from one insurer to another, as does the availability of renewals (some insurers only offer up to six months of coverage, without the option antabuse buy to renew). Because there are fewer restrictions on short-term plans, insurers have more leeway in their plan designs. This results in a lot of coverage options, but it’s important to carefully read the policy descriptions for any plans you’re considering, antabuse buy to make sure you understand what is and isn’t covered.Who can buy short-term health insurance in Missouri?.

Short-term health insurance in Missouri can be purchased by applicants who pass the antabuse buy underwriting guidelines the insurers use. This typically means being under 65 years old (some insurers put the age limit at 64 years) and in fairly good health.Short-term health insurance policies typically include blanket exclusions for any pre-existing condition that the applicant may have, so they are not adequate for residents of the Show Me State who need certain medical care for long term or ongoing conditions.If you’re in need of health insurance coverage in Missouri, your first step should be to see whether you’re eligible to enroll in an ACA-compliant major medical plan (ie, an Obamacare plan). Open enrollment for these plans runs from November 1 to December 15 each year, with coverage effective January 1 (this enrollment window applies in Missouri’s marketplace/exchange and antabuse buy also outside the exchange).You may be able to enroll in an ACA-compliant plan outside the open enrollment period, if you experience a qualifying event that triggers a special enrollment period.ACA-compliant plans are purchased on a month-to-month basis, so you can enroll in one even if you’re only going to need it for a few months before another policy takes effect.

And depending on your income, you may qualify for a premium subsidy (premium tax credit) that will make the monthly premiums much less costly than you may have been expecting. For 2021 coverage, a single individual can earn more than $51,000 and still qualify for a premium tax credit, and a family of four antabuse buy can earn up to $104,800 and still be subsidy-eligible.But if you’re not able to enroll in an employer-sponsored plan or an ACA-compliant plan, or you just cannot afford the premiums, a short-term plan will likely be a better option than remaining uninsured, despite its limitations. And even though there are no premium subsidies for short-term health insurance plans, the monthly premiums tend to be quite affordable, due to the plan limitations and the use of medical underwriting.When should I consider short-term health insurance in Missouri?.

These are times when you may need to antabuse buy consider a short-term health insurance plan:You missed open enrollment for ACA-compliant coverage and do not have a qualifying event that would trigger a special enrollment period.You’re newly employed and will soon be covered by your employer’s health plan, but they have a waiting period of up to three months before you’re eligible for coverage.You’ll soon be enrolled in Medicare, but do not have any other coverage options in the meantime. If your Medicare won’t take effect until after the start of the coming year, you can enroll in an ACA-compliant health plan during the autumn open enrollment period (November 1 – December 15), with coverage effective January 1, and then cancel it when your Medicare coverage takes effect.You’ve already enrolled in an ACA-compliant plan, but have to wait up to several weeks before it takes effect. You can use a short-term plan to bridge the gap until your new coverage is in force.You’re not eligible for Medicaid or antabuse buy a premium subsidy for marketplace coverage, making an ACA-compliant plan unaffordable.

People who are ineligible for premium subsidies include:Those who earn over 400% of the poverty level. (For 2021 coverage, that amounts to $51,040 for a single antabuse buy person. If your ACA-specific modified adjusted gross income is just a little above the subsidy-eligible threshold, there are steps you can take to reduce it).People caught by the ACA’s family glitch, which happens when an employer will provide affordable coverage to employees, but the cost to add family members to the employer’s plan is unaffordable (unfortunately, the family is still not eligible for premium subsidies in the marketplace).People who aren’t lawfully present in the U.S.

And thus are not able to enroll in a plan through antabuse buy the exchange/marketplace at all.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational antabuse buy pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Key takeaways Q.

I’ve always had a high-deductible health plan, and I’m happy antabuse buy with my coverage. I’ve heard that the Affordable Care Act allows for a catastrophic plan. Is that the antabuse buy best option for me?.

A. Although the term “catastrophic plan” has long been used as a generic catch-all phrase to describe health plans with high deductibles and little coverage for routine care, antabuse buy the ACA assigned strict parameters to the term. Catastrophic plans have limited eligibility guidelines, cannot be purchased with premium subsidies, and must provide certain limited benefits to enrollees before the deductible is met.

[Details are available in the text of the ACA, section 1303(e).]And for the antabuse buy purposes of the ACA’s risk adjustment program, catastrophic plans are in a separate risk pool from the metal-level plans, although they’re in the same general shared risk pool. This means that within a state, catastrophic plans transfer risk adjustment funds with other catastrophic plans, but not with metal-level plans. This is the antabuse buy primary mechanism by which catastrophic plans have lower prices than Bronze plans.Catastrophic plans.

High deductibles, plus primary care and preventive careCatastrophic plans cover all of the essential benefits defined by the ACA, but with very high deductibles, equal to the annual limit on out-of-pocket costs under the ACA (in 2021, this is $8,550 for a single individual).They must still limit members’ out-of-pocket costs for in-network services to no more than the annual out-of-pocket maximum that applies to all plans (again, this cap is $8,550 for an individual in 2021).Catastrophic plans cover at least three primary care visits per year before the deductible is met (copays can apply for these visits, but at least part of the cost will be paid by the insurance company, even if you haven’t met your deductible).And like all ACA-compliant plans, catastrophic plans cover certain preventive care with no cost-sharing.Other services beyond preventive care and some primary care will be paid by the insured until the deductible is met. Subsidies can’t be used to offset the cost of catastrophic plansPremium subsidies are not available for catastrophic plans (nor antabuse buy are cost-sharing subsidies, which are only available on Silver plans). Depending on your income, you may be eligible for a subsidy that you could apply towards antabuse buy a metal-rated plan.

This will likely make a metal level plan more affordable than a catastrophic plan. Only certain populations can purchase catastrophic plansCatastrophic plans are only available to people under age 30, or people 30 antabuse buy and older who qualify for a hardship/affordability exemption (which means that due to unaffordability of coverage, economic hardship, or certain other hardships – such as the death of a family member – the person is not required to maintain health insurance coverage). Regardless of age or income, catastrophic plans used to be available for people whose health insurance policies were canceled because they were not ACA compliant, but that exemption ceased to be available after the end of 2016.Although the ACA’s individual mandate penalty was eliminated after the end of 2018, the mandate itself continues to exist – there just isn’t a penalty for noncompliance anymore.

So people can antabuse buy still seek hardship exemptions from the mandate in order to gain access to catastrophic plans. (Affordability exemptions are included under the “general hardship exemption” category, as described below.)And the Trump administration expanded access to hardship exemptions in April 2018, allowing exemptions for people in areas where all plans cover abortions, areas where only one insurer (or zero insurers) offers plans in the exchange, or where a personal hardship is created due to the plan options available in the exchange.In particular, the provision for people in areas where just one insurer offers plans in the exchange makes a hardship exemption available to far more people, allowing them to potentially purchase a catastrophic plan (albeit without premium subsidies, making this a realistic alternative only for people who aren’t otherwise eligible for subsidies).Enrollment is low, partially because people don’t know they’re eligible for catastrophic plansHowever, obtaining a hardship exemption is not always a quick process, and catastrophic plans don’t automatically show up on the list of available plan options for people who are 30 or older. So it’s antabuse buy possible that many applicants are unaware that they could seek a hardship (including affordability) exemption and obtain a catastrophic plan.

A knowledgeable broker can inform applicants about catastrophic plans and guide them through the process of obtaining an exemption, but as described in this letter from a broker in Colorado, the process isn’t necessarily easy or seamless even with assistance.During the open enrollment period for 2020 coverage, only 88,944 people enrolled in catastrophic plans, out of 11.4 million exchange enrollees nationwide. The fact antabuse buy that premium subsidies can’t be used with catastrophic plans is a primary reason for the low uptake of catastrophic plans. But for the population that isn’t eligible for premium subsidies (each year, roughly 15 percent of exchange enrollees pay full price), catastrophic plans would likely be much more popular than they currently are if the plans were displayed among the available options in the browsing tools used by the exchanges.This could be accomplished automatically for affordability exemptions and there could also be a question in the plan browsing tool that asks the applicant if they’re eligible for and seeking a hardship exemption.

Exemptions based on affordability are antabuse buy granted to people for whom the lowest-cost plan in the exchange would be more than 8.24 percent of their modified adjusted gross income (MAGI) in 2020. For 2021, this threshold is 8.27 percent, and for 2022, HHS has proposed 8.47 percent.So for example, a single person with a MAGI of $52,000 (who can’t adjust their MAGI downward with contributions to an IRA and/or HSA) would not be eligible for any premium subsidies in 2021, because the income cutoff for a single person to get premium subsidies in 2021 is $51,040 in the continental US, not counting the additional subsidies that California provides). If they’re under 30, they’re automatically eligible antabuse buy for a catastrophic plan.

But if antabuse buy they’re 30 or older, they can qualify for a catastrophic plan for 2021 – based on the affordability exemption – if the cheapest available metal-level plan is more than about $358/month. (That’s 8.27 percent of their $52,000 MAGI, divided by 12 to get the monthly amount.) For a young person, it’s common to see lowest-cost metal-level plans well below that amount. But for an older applicant, the cheapest metal-level plan can still exceed 8.27 percent of even fairly high MAGIs — well above antabuse buy the cut-off for premium subsidy eligibility.However, there’s no readily available way for these applicants to see catastrophic plans when they browse their options.

The form for obtaining an exemption is lengthy and the process can take several weeks, which makes it challenging for a person to obtain an exemption number during the six-week open enrollment period that applies in most states. A savvy broker can use rate sheets to manually get catastrophic plan quotes for their clients, but there is antabuse buy not a readily available DIY option, and even for brokers, there isn’t an automated way to display catastrophic plan pricing for applicants who are 30 or older.Other reasons for low enrollmentBut catastrophic plan enrollment is low for other reasons as well. Even when it’s easy to see the pricing (ie, for an applicant under 30), catastrophic plans aren’t always the lowest-cost option for people who don’t get premium subsidies.

For example, in Cook County, Illinois, the lowest-cost plan for antabuse buy a 27-year-old for 2021 is $220/month (a Bronze plan), while the lowest-cost catastrophic plan for this person is $229/month. This pricing anomaly – with Bronze plans priced below catastrophic plans – is rare but does exist. (In this particular case, antabuse buy both plans have maximum out-of-pocket limits of $8,550.

The Bronze plan has a slightly lower deductible, at $7,400, but the catastrophic plan provides three free primary care visits during the year.)In some areas, there are no catastrophic plans available. And in some areas, the lowest-cost antabuse buy insurer doesn’t offer catastrophic plans, so even if other insurers do, the Bronze plan from the lowest-cost insurer might be less expensive than another insurer’s catastrophic plan.And some applicants are specifically looking for HSA-qualified plans so that they can contribute money to an HSA. Catastrophic plans cannot be HSA-qualified high-deductible health plans – despite their high deductibles – because they cover some non-preventive services before the deductible and because their out-of-pocket maximum is too high.Catastrophic plans are available both in and out of the ACA’s health insurance exchanges, but hardship (including affordability) exemptions for those 30 and older must be obtained from the exchange.

The Trump administration issued guidance in 2018 that allows people to claim hardship exemptions on their tax returns instead of having antabuse buy to obtain them from the exchange in their state. But that’s only useful in terms of avoiding the ACA’s individual mandate penalty (which still antabuse buy applied for 2018 but is no longer applicable). Exemptions via a tax return are granted after the year is over.

An applicant who wants to apply for a catastrophic plan must get their hardship exemption in advance in order to be able to apply for antabuse buy the catastrophic plan during open enrollment or a special enrollment period.If you’re shopping for health insurance in your state’s exchange, you’ll see catastrophic plans (assuming they’re available in your area) in addition to the Bronze, Silver, Gold and Platinum plans when you browse the available options, but only if you’re under 30 years old. If you’re 30 or older, it won’t show up as an option unless you have your exemption certificate from the exchange.Although the ACA places strict limits on who can purchase a catastrophic plan, Colorado lawmakers passed a bill in 2018 that called for a study of how expanded access to catastrophic plans would affect Colorado’s insurance market, both in terms of total subsidies received by Colorado residents, and overall premiums. Prior to seeking a waiver from the federal government that would allow anyone to purchase a catastrophic plan, the state is seeking input from the federal government about the likelihood of such a waiver being approved.Catastrophic plans are not HSA-qualifiedA health savings account (HSA) is a type of tax-advantaged account to which people can antabuse buy contribute pre-tax money as long as they’re covered by an HSA-qualified high deductible health plan (HDHP).

In layman’s terms, “catastrophic” and “high-deductible” are often used interchangeably. But in health policy, they each have strict definitions:HDHPs that allow a member to contribute to an HSA are not allowed to cover any care before the deductible, with the exception of antabuse buy preventive care, and the maximum out-of-pocket amount for an HDHP in 2021 is $7,000 for an individual (here are the IRS rules that pertain to HSAs/HDHPs).Catastrophic plans are required to cover at least three primary care visits before the deductible, and they have deductibles that are higher than the allowable limits for HDHPs (in 2021 the deductible and maximum out-of-pocket for a catastrophic plan is $8,550).So by definition, catastrophic plans cannot be HSA-qualified, and catastrophic plan enrollees cannot contribute to HSAs. If you want to be able to contribute to an HSA, you’ll need an HSA-qualified plan.

These plans can be found at the Bronze, Silver, and Gold levels, depending on the area and the insurer offering the plans, but they cannot be catastrophic plans.Very few people enroll in catastrophic plansBecause catastrophic plans are not subsidy-eligible, are only available to some enrollees, aren’t available in all areas, and aren’t automatically displayed to eligible applicants unless they’re under antabuse buy 30 years old, very few people tend to select these plans. Each year, less than 1 percent of all exchange enrollees nationwide enroll in catastrophic plans.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational antabuse buy pieces about the Affordable Care Act for healthinsurance.org.

Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

Antabuse uk

The Empire Justice Center published a report in May, 2013 exploring the policies antabuse uk that guide immigrant access check to health care and making recommendations for improving immigrant access through New York's Health Insurance Exchange. New York's Exchange Portal. A Gateway to Coverage for Immigrants The report includes a new tool -- Immigrant Eligibility Crosswalk -- Eligibility by Immigration Status-- designed to help advocates and policymakers sort through the tangle of immigrant eligibility categories to determine who is eligible for which health care programs in 2014 and beyond.

The report was made possible with support from the United Hospital Fund and benefited from the advice and input from many of our national partners in the effort to ensure maximum participation of immigrants in the nation's healthcare system as well antabuse uk as experts from the New York State Department of Health and the Centers for Medicare and Medicaid Services. SEE more about "PRUCOL" immigrant eligibility for Medicaid in this article. "Undocumented" immigrants are, with some exceptions for pregnant women and Child Health Plus, only eligible for "emergency Medicaid."NYS announced the 2020 Income and Resource levels in GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates ) and levels based on the Federal Poverty Level are in GIS 20 MA/02 – 2020 Federal Poverty Levels Here is the 2020 HRA Income and Resources Level Chart Non-MAGI - 2020 Disabled, 65+ or Blind ("DAB" or SSI-Related) and have Medicare MAGI (2020) (<.

65, Does not have Medicare)(OR has Medicare and has dependent child < antabuse uk. 18 or <. 19 in school) 138% FPL*** Children <.

5 and pregnant women have HIGHER LIMITS than shown ESSENTIAL PLAN For MAGI-eligible people antabuse uk over MAGI income limit up to 200% FPL No long term care. See info here 1 2 1 2 3 1 2 Income $875 (up from $859 in 201) $1284 (up from $1,267 in 2019) $1,468 $1,983 $2,498 $2,127 $2,873 Resources $15,750 (up from $15,450 in 2019) $23,100 (up from $22,800 in 2019) NO LIMIT** NO LIMIT SOURCE for 2019 figures is GIS 18 MA/015 - 2019 Medicaid Levels and Other Updates (PDF). All of the attachments with the various levels are posted here.

NEED TO KNOW PAST MEDICAID INCOME antabuse uk AND RESOURCE LEVELS?. Which household size applies?. The rules are complicated.

See rules here antabuse uk. On the HRA Medicaid Levels chart - Boxes 1 and 2 are NON-MAGI Income and Resource levels -- Age 65+, Blind or Disabled and other adults who need to use "spend-down" because they are over the MAGI income levels. Box 10 on page 3 are the MAGI income levels -- The Affordable Care Act changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers.

People in the "MAGI" category - those NOT on Medicare -- have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a antabuse uk "spend-down." They have NO resource limit. Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Care &. Nursing Homes and Box 8 has the Transfer Penalty rates for nursing home eligibility Box 4 has Medicaid Buy-In for Working People with Disabilities Under Age 65 (still 2017 levels til April 2018) Box 6 are Medicare Savings Program levels (will be updated in April 2018) MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school.

42 C.F.R antabuse uk. § 435.4. Certain populations have an even higher income limit - 224% FPL for pregnant women and babies <.

Age 1, antabuse uk 154% FPL for children age 1 - 19. CAUTION. What is counted as income may not be what you think.

For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained antabuse uk in this outline and these charts on income disregards. However, for the MAGI population - which is virtually everyone under age 65 who is not on Medicare - their income will now be determined under new rules, based on federal income tax concepts - called "Modifed Adjusted Gross Income" (MAGI). There are good changes and bad a knockout post changes.

GOOD. Veteran's benefits, Workers compensation, antabuse uk and gifts from family or others no longer count as income. BAD.

There is no more "spousal" or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) and some other rules. For all of the rules see antabuse uk. ALSO SEE 2018 Manual on Lump Sums and Impact on Public Benefits - with resource rules The income limits increase with the "household size." In other words, the income limit for a family of 5 may be higher than the income limit for a single person.

HOWEVER, Medicaid rules about how to calculate the household size are not intuitive or even logical. There antabuse uk are different rules depending on the "category" of the person seeking Medicaid. Here are the 2 basic categories and the rules for calculating their household size.

People who are Disabled, Aged 65+ or Blind - "DAB" or "SSI-Related" Category -- NON-MAGI - See this chart for their household size. These same rules apply antabuse uk to the Medicare Savings Program, with some exceptions explained in this article. Everyone else -- MAGI - All children and adults under age 65, including people with disabilities who are not yet on Medicare -- this is the new "MAGI" population.

Their household size will be determined using federal income tax rules, which are very complicated. New rule is explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010 antabuse uk (PDF) pp. 8-10 of the PDF, This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size.

See slides 28-49. Also seeLegal Aid antabuse uk Society and Empire Justice Center materials OLD RULE used until end of 2013 -- Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient. Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st "DAB" category.

Under this rule, a child may be excluded from the household if that child's income causes other family members to lose Medicaid eligibility. See 18 NYCRR 360-4.2, MRG p. 573, NYS GIS 2000 MA-007 CAUTION.

Different people in the same household may be in different "categories" and hence have different household sizes AND Medicaid income and resource limits. If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband's household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife's is under Category 2/MAGI. The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid.

Prenatal Care Assistance Program (PCAP) was Medicaid for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL). Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. It was sometimes known as "S/CC" category for Singles and Childless Couples.

This category had lower income limits than DAB/ADC-related, but had no asset limits. It did not allow "spend down" of excess income.

The report was made possible with support from the United Hospital Fund and benefited from the advice and input from many of our national partners in http://akrai.org/location/ the effort to ensure maximum participation of antabuse buy immigrants in the nation's healthcare system as well as experts from the New York State Department of Health and the Centers for Medicare and Medicaid Services. SEE more about "PRUCOL" immigrant eligibility for Medicaid in this article. "Undocumented" immigrants are, with some exceptions for pregnant women and Child Health Plus, only eligible for "emergency Medicaid."NYS announced the 2020 Income and Resource levels in GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates ) and levels based on the Federal Poverty Level are in GIS 20 MA/02 – 2020 Federal Poverty Levels Here is the 2020 HRA Income and Resources Level Chart Non-MAGI - 2020 Disabled, 65+ or Blind ("DAB" or SSI-Related) and have Medicare MAGI (2020) (<. 65, Does not have Medicare)(OR has Medicare and has antabuse buy dependent child <. 18 or <.

19 in school) 138% FPL*** Children <. 5 and pregnant women have HIGHER LIMITS than shown ESSENTIAL PLAN For MAGI-eligible people over MAGI income antabuse buy limit up to 200% FPL No long term care. See info here 1 2 1 2 3 1 2 Income $875 (up from $859 in 201) $1284 (up from $1,267 in 2019) $1,468 $1,983 $2,498 $2,127 $2,873 Resources $15,750 (up from $15,450 in 2019) $23,100 (up from $22,800 in 2019) NO LIMIT** NO LIMIT SOURCE for 2019 figures is GIS 18 MA/015 - 2019 Medicaid Levels and Other Updates (PDF). All of the attachments with the various levels are posted here. NEED TO KNOW PAST MEDICAID INCOME antabuse buy AND RESOURCE LEVELS?.

Which household size applies?. The rules are complicated. See rules antabuse buy here. On the HRA Medicaid Levels chart - Boxes 1 and 2 are NON-MAGI Income and Resource levels -- Age 65+, Blind or Disabled and other adults who need to use "spend-down" because they are over the MAGI income levels. Box 10 on page 3 are the MAGI income levels -- The Affordable Care Act changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers.

People in the "MAGI" category - those NOT on Medicare -- have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be antabuse buy eligible for Medicaid without a "spend-down." They have NO resource limit. Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Care &. Nursing Homes and Box 8 has the Transfer Penalty rates for nursing home eligibility Box 4 has Medicaid Buy-In for Working People with Disabilities Under Age 65 (still 2017 levels til April 2018) Box 6 are Medicare Savings Program levels (will be updated in April 2018) MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school. 42 C.F.R antabuse buy. § 435.4.

Certain populations have an even higher income limit - 224% FPL for pregnant women and babies <. Age 1, 154% FPL for children antabuse buy age 1 - 19. CAUTION. What is counted as income may not be what you think. For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this outline and these charts on antabuse buy income disregards.

However, for the MAGI population - which is virtually everyone under age 65 who is not on Medicare - their income will now be determined under new rules, based on federal income tax concepts - called "Modifed Adjusted Gross Income" (MAGI). There are good changes and bad changes. GOOD antabuse buy. Veteran's benefits, Workers compensation, and gifts from family or others no longer count as income. BAD http://www.kampfirejournal.com/?post_type=feedback&p=1000.

There is no more "spousal" or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) and some other rules. For all of the rules see antabuse buy. ALSO SEE 2018 Manual on Lump Sums and Impact on Public Benefits - with resource rules The income limits increase with the "household size." In other words, the income limit for a family of 5 may be higher than the income limit for a single person. HOWEVER, Medicaid rules about how to calculate the household size are not intuitive or even logical. There are different rules depending on the "category" of the person antabuse buy seeking Medicaid.

Here are the 2 basic categories and the rules for calculating their household size. People who are Disabled, Aged 65+ or Blind - "DAB" or "SSI-Related" Category -- NON-MAGI - See this chart for their household size. These same rules apply to the Medicare Savings Program, with some exceptions explained antabuse buy in this article. Everyone else -- MAGI - All children and adults under age 65, including people with disabilities who are not yet on Medicare -- this is the new "MAGI" population. Their household size will be determined using federal income tax rules, which are very complicated.

New rule is explained in State's directive 13 ADM-03 - Medicaid antabuse buy Eligibility Changes under the Affordable Care Act (ACA) of 2010 (PDF) pp. 8-10 of the PDF, This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size. See slides 28-49. Also seeLegal Aid Society and Empire Justice Center materials OLD RULE used until end of 2013 -- Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA, ADC, or SSI and antabuse buy reside with an applicant/recipient. Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st "DAB" category.

Under this rule, a child may be excluded from the household if that child's income causes other family members to lose Medicaid eligibility. See 18 NYCRR 360-4.2, antabuse buy MRG p. 573, NYS GIS 2000 MA-007 CAUTION. Different people in the same household may be in different "categories" and hence have different household sizes AND Medicaid income and resource limits. If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband's household size for Medicaid is antabuse buy determined under Category 1/ Non-MAGI above and his wife's is under Category 2/MAGI.

The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid. Prenatal Care Assistance Program (PCAP) was Medicaid for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL). Medicaid for adults between ages antabuse buy 21-65 who are not disabled and without children under 21 in the household. It was sometimes known as "S/CC" category for Singles and Childless Couples. This category had lower income limits than DAB/ADC-related, but had no asset limits.

It did antabuse buy not allow "spend down" of excess income. This category has now been subsumed under the new MAGI adult group whose limit is now raised to 138% FPL. Family Health Plus - this was an expansion of Medicaid to families with income up to 150% FPL and for childless adults up to 100% FPL. This has now been folded into the new MAGI adult group whose limit is 138% FPL.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

Marcus is classically conditioned with antabuse

Dear Reader, Thank you marcus is classically conditioned with antabuse for following the Me&MyDoctor blog. I'm writing to let you know we are moving the public health stories authored by Texas physicians, residents, and medical students, and patients to the Texas Medical Association's social media channels. Be sure to follow us on all our social media accounts (Facebook, Twitter, marcus is classically conditioned with antabuse Instagram) as well as Texas Medicine Today to access these stories and more.

We look forward to seeing you there.Best, Olivia Suarez Me&My Doctor EditorSravya Reddy, MDPediatric Resident at The University of Texas at Austin Dell Medical SchoolMember, Texas Medical AssociationHow does the alcoholism treatment antabuse factor into potentially abusive situations?. To stop the spread of alcoholism treatment, we have isolated ourselves into small family units to avoid catching and transmitting the antabuse. While saving so many marcus is classically conditioned with antabuse from succumbing to a severe illness, socially isolating has unfortunately posed its own problems.

Among those is the increased threat of harm from intimate partner violence, which includes physical violence, sexual violence, stalking, or psychological harm by a current or former partner or spouse. Potential child abuse is an increased threat as well. The impact of this antabuse happened so rapidly that society marcus is classically conditioned with antabuse did not have time to think about all the consequences of social isolation before implementing it.

Now those consequences are becoming clear.Social isolation due to the antabuse is forcing victims to stay home indefinitely with their abusers. Children and adolescents also have been forced to stay at home since many school districts have made education virtual to keep everyone safe from the antabuse. Caregivers are also home marcus is classically conditioned with antabuse because they are working remotely or because they are unemployed.

With the increase in the number of alcoholism treatment cases, financial strain due to the economic downturn, and concerns of contracting the antabuse and potentially spreading it to family members, these are highly stressful times. Stress leads to an increase in the rate of intimate partner violence. Even those who suffer from it can begin to become abusive to other household members, thus amplifying the marcus is classically conditioned with antabuse abuse in the household.

Some abuse may go unrecognized by the victims themselves. For example, one important and less well-known type of marcus is classically conditioned with antabuse abuse is coercive control. It’s the type of abuse that doesn’t leave a physical mark, but it’s emotional, verbal, and controlling.

Victims often know that something is wrong – but can’t quite identify what it is. Coercive control marcus is classically conditioned with antabuse can still lead to violent physical abuse, and murder. The way in which people report abuse has also been altered by the antabuse.People lacking usual in-person contacts (with teachers, co-workers, or doctors) and the fact that some types of coercive abuse are less recognized lead to fewer people reporting that type of abuse.

Child abuse often is discovered during pediatricians’ well-child visits, but the antabuse has limited those visits. Many teachers, who might also notice signs of abuse, marcus is classically conditioned with antabuse also are not able to see their students on a daily basis. Some abuse victims visit emergency departments (EDs) in normal times, but ED visits are also down due to alcoholism treatment.Local police in China report that intimate partner violence has tripled in the Hubei province.

The United Nations reports it also increased 30% in France as of March 2020 and increased 25% in Argentina. In the marcus is classically conditioned with antabuse U.S. The conversation about increased intimate partner violence during these times has just now started, and we are beginning to gather data.

Preliminary analysis shows police reports of intimate partner violence have increased by 18% to 27% across several U.S. Cities. Individuals affected by addiction have additional stressors and cannot meet with support groups.

Children and adolescents who might otherwise use school as a form of escape from addicted caregivers are no longer able to do so. Financial distress can also play a factor. According to research, the rate of violence among couples with more financial struggles is nearly three and a half times higher than couples with fewer financial concerns.Abuse also can come from siblings.

Any child or adolescent with preexisting behavioral issues is more likely to act out due to seclusion, decreased physical activity, or fewer positive distractions. This could increase risk for others in the household, especially in foster home situations. These other residents might be subject to increased sexual and physical abuse with fewer easy ways to report it.

What can we do about this while abiding by the rules of the antabuse?. How can physicians help?. Patients who are victims of intimate partner violence are encouraged to reach out to their doctor.

A doctor visit may be either in person or virtual due to the safety precautions many doctors’ offices are enforcing due to alcoholism treatment. During telehealth visits, physicians should always ask standard questions to screen for potential abuse. They can offer information to all patients, regardless of whether they suspect abuse.People could receive more support if we were to expand access to virtual addiction counseling, increase abuse counseling, and launch more campaigns against intimate partner violence.

The best solution might involve a multidisciplinary team, including psychiatrists, social workers, child abuse teams and Child Protective Services, and local school boards. Physicians can help in other ways, too. Doctors can focus on assessing mental health during well-child and acute clinic visits and telehealth visits.

A temporary screening tool for behavioral health during the antabuse might be beneficial. Governments could consider allocating resources to telepsychiatry. Many paths can be taken to reduce the burden of mental health issues, and this is an ongoing discussion.

How should physicians approach patients who have or may have experienced intimate partner violence?. Victims of domestic assault can always turn to their physician for guidance on next steps. In response, doctors can:Learn about local resources and have those resources available to your patients;Review safety practices, such as deleting internet browsing history or text messages.

Saving abuse hotline information under other listings, such as a grocery store or pharmacy listing. And creating a new, confidential email account for receiving information about resources or communicating with physicians.If the patient discloses abuse, the clinician and patient can establish signals to identify the presence of an abusive partner during telemedicine appointments.To my fellow physicians, I suggest recognizing and talking about the issue with families.Medical professionals take certain steps if they suspect their patient’s injuries are a result of family violence, or if the patient discloses family violence. Physicians will likely screen a patient, document their conversation with the patient, and offer support and inform the patient of the health risks of staying in an abusive environment, such as severe injuries or even death.

A doctor’s priority is his or her patient’s safety, regardless of why the victim might feel forced to remain in an abusive environment. While physicians only report child and elderly abuse, they should encourage any abused patient to report her or his own case, while also understanding the complexity of the issue. Under no circumstance should any form of abuse be tolerated or suffered.

Any intimate partner violence should be avoided, and reported if possible and safe. My hope is that with more awareness of this rising public health concern, potential victims can better deal with the threat of abuse during this stressful antabuse – and hopefully avoid it..

Dear Reader, antabuse buy Thank you for following the Me&MyDoctor blog. I'm writing to let you know we are moving the public health stories authored by Texas physicians, residents, and medical students, and patients to the Texas Medical Association's social media channels. Be sure to follow us on all our social media accounts (Facebook, Twitter, Instagram) as well as Texas Medicine Today antabuse buy to access these stories and more. We look forward to seeing you there.Best, Olivia Suarez Me&My Doctor EditorSravya Reddy, MDPediatric Resident at The University of Texas at Austin Dell Medical SchoolMember, Texas Medical AssociationHow does the alcoholism treatment antabuse factor into potentially abusive situations?. To stop the spread of alcoholism treatment, we have isolated ourselves into small family units to avoid catching and transmitting the antabuse.

While saving so many from succumbing to a severe illness, socially isolating has unfortunately posed its own antabuse buy problems. Among those is the increased threat of harm from intimate partner violence, which includes physical violence, sexual violence, stalking, or psychological harm by a current or former partner or spouse. Potential child abuse is an increased threat as well. The impact antabuse buy of this antabuse happened so rapidly that society did not have time to think about all the consequences of social isolation before implementing it. Now those consequences are becoming clear.Social isolation due to the antabuse is forcing victims to stay home indefinitely with their abusers.

Children and adolescents also have been forced to stay at home since many school districts have made education virtual to keep everyone safe from the antabuse. Caregivers are also home because they antabuse buy are working remotely or because they are unemployed. With the increase in the number of alcoholism treatment cases, financial strain due to the economic downturn, and concerns of contracting the antabuse and potentially spreading it to family members, these are highly stressful times. Stress leads to an increase in the rate of intimate partner violence. Even those who suffer from it can begin to become abusive to other household members, antabuse buy thus amplifying the abuse in the household.

Some abuse may go unrecognized by the victims themselves. For example, one important and less well-known antabuse buy type of abuse is coercive control. It’s the type of abuse that doesn’t leave a physical mark, but it’s emotional, verbal, and controlling. Victims often know that something is wrong – but can’t quite identify what it is. Coercive control can still lead to violent antabuse buy physical abuse, and murder.

The way in which people report abuse has also been altered by the antabuse.People lacking usual in-person contacts (with teachers, co-workers, or doctors) and the fact that some types of coercive abuse are less recognized lead to fewer people reporting that type of abuse. Child abuse often is discovered during pediatricians’ well-child visits, but the antabuse has limited those visits. Many teachers, who might also notice signs of abuse, also are not able antabuse buy to see their students on a daily basis. Some abuse victims visit emergency departments (EDs) in normal times, but ED visits are also down due to alcoholism treatment.Local police in China report that intimate partner violence has tripled in the Hubei province. The United Nations reports it also increased 30% in France as of March 2020 and increased 25% in Argentina.

In the antabuse buy U.S. The conversation about increased intimate partner violence during these times has just now started, and we are beginning to gather data. Preliminary analysis shows police reports of intimate partner violence have increased by 18% to 27% across several U.S. Cities. Individuals affected by addiction have additional stressors and cannot meet with support groups.

Children and adolescents who might otherwise use school as a form of escape from addicted caregivers are no longer able to do so. Financial distress can also play a factor. According to research, the rate of violence among couples with more financial struggles is nearly three and a half times higher than couples with fewer financial concerns.Abuse also can come from siblings. Any child or adolescent with preexisting behavioral issues is more likely to act out due to seclusion, decreased physical activity, or fewer positive distractions. This could increase risk for others in the household, especially in foster home situations.

These other residents might be subject to increased sexual and physical abuse with fewer easy ways to report it. What can we do about this while abiding by the rules of the antabuse?. How can physicians help?. Patients who are victims of intimate partner violence are encouraged to reach out to their doctor. A doctor visit may be either in person or virtual due to the safety precautions many doctors’ offices are enforcing due to alcoholism treatment.

During telehealth visits, physicians should always ask standard questions to screen for potential abuse. They can offer information to all patients, regardless of whether they suspect abuse.People could receive more support if we were to expand access to virtual addiction counseling, increase abuse counseling, and launch more campaigns against intimate partner violence. The best solution might involve a multidisciplinary team, including psychiatrists, social workers, child abuse teams and Child Protective Services, and local school boards. Physicians can help in other ways, too. Doctors can focus on assessing mental health during well-child and acute clinic visits and telehealth visits.

A temporary screening tool for behavioral health during the antabuse might be beneficial. Governments could consider allocating resources to telepsychiatry. Many paths can be taken to reduce the burden of mental health issues, and this is an ongoing discussion. How should physicians approach patients who have or may have experienced intimate partner violence?. Victims of domestic assault can always turn to their physician for guidance on next steps.

In response, doctors can:Learn about local resources and have those resources available to your patients;Review safety practices, such as deleting internet browsing history or text messages. Saving abuse hotline information under other listings, such as a grocery store or pharmacy listing. And creating a new, confidential email account for receiving information about resources or communicating with physicians.If the patient discloses abuse, the clinician and patient can establish signals to identify the presence of an abusive partner during telemedicine appointments.To my fellow physicians, I suggest recognizing and talking about the issue with families.Medical professionals take certain steps if they suspect their patient’s injuries are a result of family violence, or if the patient discloses family violence. Physicians will likely screen a patient, document their conversation with the patient, and offer support and inform the patient of the health risks of staying in an abusive environment, such as severe injuries or even death. A doctor’s priority is his or her patient’s safety, regardless of why the victim might feel forced to remain in an abusive environment.

While physicians only report child and elderly abuse, they should encourage any abused patient to report her or his own case, while also understanding the complexity of the issue. Under no circumstance should any form of abuse be tolerated or suffered. Any intimate partner violence should be avoided, and reported if possible and safe. My hope is that with more awareness of this rising public health concern, potential victims can better deal with the threat of abuse during this stressful antabuse – and hopefully avoid it..

What is antabuse prescribed for

Credit http://www.ec-ebersheim.ac-strasbourg.fr/Adm/?p=1 what is antabuse prescribed for. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population what is antabuse prescribed for.

The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a what is antabuse prescribed for situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over.

The prevalence what is antabuse prescribed for of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids.

The findings translate to a fivefold increased risk of uterine fibroids in women what is antabuse prescribed for with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between what is antabuse prescribed for the two conditions remains unclear,” she says.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says what is antabuse prescribed for. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors on this paper were Ginette what is antabuse prescribed for A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit.

The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors what is antabuse prescribed for across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors. - Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known what is antabuse prescribed for as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows.

The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future what is antabuse prescribed for clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would http://nms.langschlag.at/unser-beitrag-zur-muellvermeidung/ fight an . These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced what is antabuse prescribed for melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma.

The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better what is antabuse prescribed for than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on what is antabuse prescribed for outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with what is antabuse prescribed for different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation.

The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the what is antabuse prescribed for differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one of those what is antabuse prescribed for things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a what is antabuse prescribed for rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors.

However, he explains, this cancer type is often caused by a antabuse, which seems to encourage a strong immune response despite the cancer’s lower mutational burden. In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors what is antabuse prescribed for on cancer types for which these drugs haven’t yet been tried.

Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by what is antabuse prescribed for investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

Credit antabuse order online antabuse buy. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects antabuse buy black women and is the most common form of permanent alopecia in this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb.

Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the antabuse buy skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients with and antabuse buy without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition.

In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, antabuse buy compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she antabuse buy says.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous antabuse buy tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition. The other authors on this paper were antabuse buy Ginette A.

Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has antabuse buy on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel antabuse buy Cancer Center researchers shows. The finding, published in the Dec. 21 New England Journal antabuse buy of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines have had remarkable antabuse buy success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to antabuse buy immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow.

Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types antabuse buy was unclear. To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients antabuse buy with different tumor types.

Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that antabuse buy cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one of those things that doesn’t sound right when you hear it,” says antabuse buy Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number antabuse buy of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a antabuse, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test antabuse buy checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs.

€œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says. Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

Antabuse 200mg

Start Preamble antabuse 200mg http://theorganicrabbit.com/quinao-stuffed-sweet-potatoes/ Start Printed Page 40921 U.S. Small Business Administration. Interim final antabuse 200mg rule. This interim final rule implements changes related to the forgiveness of loans made under the Paycheck Protection Program (PPP), which was originally established under the alcoholism Aid, Relief, and Economic Security Act (CARES Act) to provide economic relief to small businesses nationwide adversely impacted by the alcoholism Disease 2019 (alcoholism treatment), as amended. SBA has issued a number of interim final rules implementing the PPP Program.

This interim final rule further streamlines the forgiveness process for PPP loans of $150,000 or less by allowing lenders to use a alcoholism treatment Revenue Reduction Score at the time of forgiveness to document the required revenue reduction for Second Draw PPP Loans, and establishing a direct borrower forgiveness process for lenders antabuse 200mg that choose to opt-in as an alternative method of processing loan forgiveness applications. This interim final rule also extends the loan deferment period for those PPP loans where the borrower timely files an appeal of a final SBA loan review decision with the SBA Office of Hearings and Appeals. Effective date antabuse 200mg. The provisions of this interim final rule are effective July 28, 2021. Applicability date.

The alcoholism treatment Revenue Reduction Score portion of this interim final rule applies to all Second Draw PPP Loans for which antabuse 200mg the lender has not yet issued a loan forgiveness decision to SBA as of the effective date of this rule. The direct borrower forgiveness process portion of this rule applies to all PPP loans for which a loan forgiveness application has not been submitted by the borrower to the lender as of the effective date of this rule. The deferment portion of the rule applies to PPP appeals filed after the effective date of this rule and to those PPP appeals filed before the effective date of this rule for which a Notice and Order has not been issued. Comment date antabuse 200mg. Comments must be received on or before August 30, 2021.

You may submit comments, identified by docket antabuse 200mg number SBA-2021-0015 through the Federal eRulemaking Portal. Http://www.regulations.gov. Follow the instructions for submitting comments. SBA will post all comments on www.regulations.gov antabuse 200mg. If you wish to submit confidential business information (CBI) as defined in the User Notice at www.regulations.gov, please send an email to ppp-ifr@sba.gov.

All other antabuse 200mg comments must be submitted through the Federal eRulemaking Portal described above. Highlight the information that you consider to be CBI and explain why you believe SBA should hold this information as confidential. SBA will review the information and make the final determination whether it will publish the information. Start Further Info A Call Center Representative at 833-572-0502 or the local SBA Field Office antabuse 200mg. The list of offices can be found at https://www.sba.gov/​tools/​local-assistance/​districtoffices.

If you use a telecommunications device for the deaf (TDD) or a text telephone (TTY), call the Federal Relay Service (FRS), toll free, at 1-800-877-8339. Individuals with disabilities can obtain this document in an accessible format that may be provided in Rich Text Format (RTF) or text format (txt), a thumb drive, an mp3 file, Braille, large print, audiotape, or antabuse 200mg compact disc, or other accessible formats. End Further Info End Preamble Start Supplemental Information I. Background Information On March 27, 2020, the alcoholism Aid, antabuse 200mg Relief, and Economic Security Act (CARES Act) (Pub. L.

116-136) was enacted to provide emergency assistance and health care response for individuals, families, and businesses affected by the alcoholism Disease 2019 (alcoholism treatment) antabuse. Section 1102 of the CARES Act temporarily permitted the Small Business Administration (SBA) to guarantee 100 percent of 7(a) loans under a new program titled the “Paycheck Protection Program,” pursuant to antabuse 200mg section 7(a)(36) of the Small Business Act (15 U.S.C. 636(a)(36)) (First Draw PPP Loans). Section 1106 of the CARES Act provided for forgiveness of up to the full principal amount of qualifying loans guaranteed under the antabuse 200mg Paycheck Protection Program (PPP). On April 24, 2020, the Paycheck Protection Program and Health Care Enhancement Act (Pub.

L. 116-139) was enacted, which provided additional funding and authority for antabuse 200mg the PPP Program. On June 5, the Paycheck Protection Program Flexibility Act of 2020 (PPP Flexibility Act) (Pub. L. 116-142) was antabuse 200mg enacted, which changed provisions of the PPP relating to the maturity of PPP loans, the deferral of PPP loan payments, and the forgiveness of PPP loans.

On July 4, 2020, Public Law 116-147 extended the authority to guarantee PPP loans to August 8, 2020. On December 27, 2020, the Economic Aid to Hard-Hit Small Businesses, Nonprofits and Venues Act (Economic antabuse 200mg Aid Act) (Pub. L. 116-260) was enacted. The Economic Aid Act reauthorized lending under the PPP antabuse 200mg through March 31, 2021.

The Economic Aid Act added a new temporary section 7(a)(37) to the Small Business Act, which authorizes SBA to guarantee additional PPP loans (Second Draw PPP Loans) to certain eligible borrowers that previously received a First Draw PPP Loan under generally the same terms and conditions available under section 7(a)(36) of the Small Business Act. Among other things, to be eligible for a Second Draw PPP Loan, the borrower must antabuse 200mg have experienced a revenue reduction of not less than 25% in at least one quarter of 2020 compared to the same quarter in 2019. The Economic Aid Act also redesignated section 1106 of the CARES Act as section 7A of the Small Business Act, to appear after section 7 of the Small Business Act. Additionally, the Economic Aid Act provided for a simplified forgiveness application process for PPP loans of $150,000 or less. On March 11, 2021, the American Rescue Plan antabuse 200mg Act (ARPA) (Pub.

L. 117-2) was enacted, and among other things, expanded eligibility for First Draw PPP Loans and Second Draw PPP Loans and revised exclusions from payroll costs for purposes of forgiveness. On March 30, 2021, the PPP Extension antabuse 200mg Act of 2021 (Pub. L. 117-6) was enacted, extending SBA's PPP program authority antabuse 200mg through June 30, 2021.

From April 3, 2020, through August 8, 2020, when the 2020 round of PPP expired, SBA guaranteed over 5.2 million PPP loans made by over 5,000 PPP lenders under delegated authority. From January 11, 2021, when the PPP reopened, through June 30, 2021, when the PPP program authority expired, SBA guaranteed over 6.6 million additional PPP loans. Thus, the total number of PPP loans guaranteed antabuse 200mg by SBA exceeds 11.8 million.[] The total dollar amount of Start Printed Page 40922the PPP loans guaranteed by SBA exceeds $806 billion. SBA posted the first interim final rule implementing the PPP on SBA's website on April 2, 2020, and published the rule in the Federal Register on April 15, 2020 (85 FR 20811). SBA subsequently antabuse 200mg issued numerous additional interim final rules.

On June 1, 2020, SBA published an interim final rule on loan forgiveness requirements (85 FR 33004) and an interim final rule on loan review procedures (85 FR 33010). Prior to the publication of the loan forgiveness and loan review interim final rules, on May 15, 2020, SBA issued SBA Form 3508, which was a loan forgiveness application to be used by all PPP borrowers. On June 26, 2020, SBA published an antabuse 200mg interim final rule revising the loan forgiveness and loan review procedures to conform to the key forgiveness changes made by the PPP Flexibility Act (85 FR 38304). In conjunction with the rule, SBA issued a second loan forgiveness application form, SBA Form 3508EZ, which is a streamlined form that incorporates the forgiveness safe harbors established under the PPP Flexibility Act. SBA's 2020 PPP program authority expired on August 8, 2020.

On August 10, 2020, SBA began accepting PPP lender decisions on antabuse 200mg PPP borrower loan forgiveness applications through SBA's Paycheck Protection Platform (Platform) (forgiveness.sba.gov). PPP borrowers were required to submit their loan forgiveness applications to their PPP lenders, and as required by section 1106 of the CARES Act (now section 7A of the Small Business Act), lenders were required to issue a decision to SBA on the borrower's loan forgiveness application within 60 days of receipt of the application. On August 27, 2020, SBA issued an interim final rule on Appeals of SBA Loan Review Decisions under the Paycheck Protection Program (85 FR antabuse 200mg 52883). On October 2, 2020, SBA began remitting forgiveness payments to PPP lenders that submitted forgiveness decisions to SBA through the Platform. SBA continues to remit forgiveness payments to PPP lenders, and as of July 12, 2021, SBA has remitted over 4.3 million forgiveness payments to lenders.[] On October 19, 2020, in response to borrower and lender concerns about the complexity of the loan forgiveness process for the smallest of borrowers, SBA and the Department of the Treasury (Treasury) jointly issued an interim final rule revising the loan forgiveness and loan review procedures to simplify the forgiveness process for PPP loans of $50,000 or less.

Among other things, the rule exempted borrowers with loans of $50,000 or less from the full-time equivalent employee (FTE) and salary/wage reduction penalties included in section 1106 of the CARES Act, under the joint SBA/Treasury statutory authority to make antabuse 200mg de minimis exemptions to those penalties. In conjunction with the rule, SBA issued a third loan forgiveness application, SBA Form 3508S, which was a further streamlined loan forgiveness application available for use by borrowers with loans of $50,000 or less. On January 14, 2021, SBA published interim final rules implementing the Economic Aid Act amendments to the PPP. The first interim final rule implemented Economic Aid Act changes to, among other things, PPP eligibility, and consolidated numerous prior interim final rules on PPP (86 FR 3692) (Consolidated antabuse 200mg Eligibility IFR). The second interim final rule implemented the Second Draw PPP Loan program authorized by the Economic Aid Act under section 7(a)(37) of the Small Business Act (86 FR 3712) (Second Draw IFR).

On February 5, 2021, SBA published a third interim final rule implementing Economic Aid Act changes related to the forgiveness and review of PPP loans (86 FR 8283) (Consolidated Forgiveness and Loan Review antabuse 200mg IFR). Among other things, the Consolidated Forgiveness and Loan Review IFR implemented the simplified forgiveness application process for loans of $150,000 or less required by the Economic Aid Act. In conjunction with this rule, on January 19, 2021, SBA issued a revised SBA Form 3508S, which increased the loan amount for which the form could be used from $50,000 to $150,000.[] The new SBA Form 3508S was also shortened to one page, as required by the Economic Aid Act, and no longer requires the submission of supporting forgiveness documentation, as mandated by the Economic Aid Act. Following the publication of the interim final rules implementing the Economic Aid Act, SBA published another antabuse 200mg interim final rule on March 8, 2021, revising certain loan amount calculation and eligibility provisions for PPP (86 FR 13149). On March 22, 2021, SBA published an interim final rule implementing the PPP provisions of ARPA (86 FR 15083).

As described below, this interim final rule further streamlines the forgiveness process for PPP loans of $150,000 or less by antabuse 200mg (a) allowing lenders to use a alcoholism treatment Revenue Reduction Score at the time of loan forgiveness to document the required revenue reduction for Second Draw PPP loans of $150,000 or less, and (b) establishing a direct borrower forgiveness process for lenders that choose to opt-in as an alternative method of processing loan forgiveness applications for PPP Loans of $150,000 or less. This interim final rule also extends the loan deferment period for those PPP loans where the borrower timely files an appeal of a final SBA loan review decision with the SBA Office of Hearings and Appeals. II. Comments and Immediate Effective Date This interim final rule is being issued without advance notice and public comment because section 1114 of the CARES Act and antabuse 200mg section 303 of the Economic Aid Act authorize SBA to issue regulations to implement the Paycheck Protection Program without regard to notice requirements. Even otherwise, SBA finds good cause for setting aside the advance notice-and-public-comment procedure because that procedure would be impracticable and contrary to the public interest.

The intent of the CARES Act and the Economic Aid Act is to afford SBA the flexibility to provide relief to America's small businesses and nonprofit organizations expeditiously. Given the urgent need to provide borrowers with timely relief, the purpose of the antabuse 200mg rule is to minimize the burdens of the current loan forgiveness process that, without modification, could result in borrowers unnecessarily having to make principal and interest payments on loans that should be forgiven. If SBA were to follow the advance notice-and-public-comment process, that would delay issuance of the rule by at least three months. SBA understands—based on its expertise and consistent portfolio analysis—that a significant number of borrowers will have to apply antabuse 200mg for loan forgiveness in the next three months. Therefore, if the proposed rule is still undergoing notice and comment during that time, these borrowers will be applying under the current process, which (as noted above) would mean these borrowers could unnecessarily have to make principal and interest payments on loans that should be forgiven and would not be positively Start Printed Page 40923impacted by a later rule change.

Providing for notice and comment would render the rule effectively moot and useless for millions of intended beneficiaries. For these same reasons, SBA has determined that it is impractical and not in the public interest to provide a 30-day delayed effective antabuse 200mg date. An immediate effective date will allow SBA to expedite loan forgiveness to small businesses and nonprofit organizations and remit forgiveness payments to lenders. This good cause justification also supports antabuse 200mg waiver of the 60-day delayed effective date for major rules under Subtitle E of the Small Business Regulatory Enforcement Fairness Act of 1996 (also known as the Congressional Review Act) at 5 U.S.C. 808(2).

Although this interim final rule is effective immediately, comments are solicited from interested members of the public on all aspects of the interim final rule. These comments must be submitted antabuse 200mg on or before August 30, 2021. SBA will consider these comments and the need for making any revisions as a result of these comments. III. Paycheck Protection Program—alcoholism treatment Revenue Reduction Score, Direct Borrower Forgiveness Process, and Appeals Deferment antabuse 200mg Overview A.

Further Streamlining Forgiveness for PPP Loans of $150,000 or Less A key feature of the PPP is that a borrower may obtain forgiveness of up to the full amount of its PPP loan provided that the borrower complied with PPP requirements. Since SBA issued the first loan forgiveness application form (SBA Form 3508) in May 2020 and published the first loan forgiveness and loan review rules antabuse 200mg in June 2020, SBA has received comments from borrowers and lenders that the loan forgiveness process is overwhelming and difficult to manage and requesting simplification of the process. In response to borrower and lender requests for simplification of the loan forgiveness process, Congress enacted the PPP Flexibility Act in June 2020, which created safe harbors from the FTE and salary/wage reduction penalties of section 1106 of the CARES Act, and in response, SBA issued a new streamlined loan forgiveness application (SBA Form 3508EZ) implementing those changes. In October 2020, SBA and Treasury exempted borrowers with loans of $50,000 or less from the FTE and salary/wage reduction penalties and issued a second new streamlined loan forgiveness application (SBA Form 3508S) implementing those changes. Borrowers and lenders continued to express concerns about the complexity of the loan forgiveness process, and in December 2020, Congress enacted the Economic Aid Act, which provides for a simplified loan forgiveness application process for borrowers antabuse 200mg with loans of $150,000 or less.

SBA implemented this requirement by revising the second streamlined loan forgiveness application (SBA Form 3508S) to allow all borrowers with loans of $150,000 or less to use the form. Loans of $150,000 or antabuse 200mg less represent 93 percent of the outstanding PPP loans. Despite the implementation of the streamlined loan forgiveness application for borrowers with loans of $150,000 or less, many smaller PPP lenders continue to express concerns to SBA that they do not have the technology or human resources to develop efficient electronic loan forgiveness platforms to process the new streamlined loan forgiveness application.[] SBA has also become aware that because lenders are overwhelmed by the volume of PPP loans and are mindful of the statutory 60-day requirement for lenders to issue a forgiveness decision to SBA from receipt of the borrower's loan forgiveness application, lenders are limiting when loan forgiveness applications are accepted from borrowers, creating uncertainty among borrowers that they are going to have to start making payments on their PPP loans while they are waiting for their lenders to accept and process their loan forgiveness applications. Additionally, SBA has heard concerns from PPP lenders of all sizes that the requirement for borrowers to submit and lenders to review at the time of forgiveness the revenue reduction documentation for Second Draw PPP Loans of $150,000 or less is delaying the forgiveness process for these borrowers. To further simplify and streamline the antabuse 200mg forgiveness process for loans $150,000 or less, SBA is making two changes under this interim final rule.

First, for Second Draw PPP Loans of $150,000 or less, where the borrower is required to provide revenue reduction documentation at the time of loan forgiveness, SBA is allowing lenders to use a alcoholism treatment Revenue Reduction Score developed by SBA's contractor as an optional method to document the borrower's revenue reduction. Second, SBA is making available a direct borrower forgiveness process for lenders that choose to opt-in as an alternative method for processing borrower loan forgiveness applications for all PPP loans of $150,000 or less. 1. alcoholism treatment Revenue Reduction Score Among other things, to be eligible for a Second Draw PPP Loan, a PPP borrower is required to have experienced a revenue reduction of not less than 25% during one quarter of 2020 compared to the same quarter in 2019. Under section 7(a)(37)(I) of the Small Business Act, when a borrower applies for a Second Draw PPP Loan of $150,000 or less, the borrower can submit a certification that the borrower meets the revenue reduction standard, provided that on or before the date on which the borrower submits an application for loan forgiveness, the borrower produces adequate documentation that the borrower has met the revenue reduction standard.

All Second Draw PPP Loan borrowers were required to certify on their loan applications (SBA Forms 2483-SD and 2483-SD-C) that they realized a reduction in gross receipts in excess of 25% relative to the relevant comparison time period. The Second Draw PPP Loan IFR and the Loan Forgiveness and Loan Review IFR implementing the Economic Aid Act provide that if a borrower with a Second Draw PPP Loan of $150,000 or less did not produce documentation of revenue reduction at the time of application, the borrower must, on or before the date the borrower applies for loan forgiveness, submit to the lender documentation adequate to establish that the borrower experienced a revenue reduction of 25% or greater in 2020 relative to 2019, and such documentation may include relevant tax forms, including annual tax forms, or if relevant tax forms are not available, quarterly financial statements or bank statements. The rules also provide that where a borrower with a Second Draw PPP Loan of $150,000 or less does not provide documentation of revenue reduction with its loan application, the lender must perform a good faith review of the documents provided by the borrower at or before forgiveness, including the borrower's calculations and supporting documents.[] Start Printed Page 40924 To streamline forgiveness of Second Draw PPP Loans of $150,000 or less where the borrower did not submit documentation of revenue reduction at the time of the loan application, SBA has determined that an alternative form of revenue reduction confirmation is warranted to document the borrower's revenue reduction. An independent third-party SBA contractor has developed a alcoholism treatment Revenue Reduction Score (score) based on a variety of inputs including industry, geography, and business size. The score uses current data on economic recovery and return of businesses to operational status.[] Each Second Draw PPP Loan of $150,000 or less will be assigned a score, which will be maintained in the Platform and will be visible to lenders to use on an optional basis as an alternative to document revenue reduction.

Additionally, the score will be visible to those borrowers that submit their loan forgiveness applications through the Platform using the direct borrower forgiveness process. When the score meets or exceeds the value required for validation of the borrower's revenue reduction, use of the score will satisfy the requirement for the borrower to document revenue reduction. When the score does not meet the value required for validation of the borrower's revenue reduction, and if the borrower has not already provided documentation to the lender that validates the borrower's revenue reduction, the borrower must provide documentation either directly to the lender (for those lenders that do not opt-in to the direct borrower forgiveness process) or provide documentation to the lender by uploading it to the Platform. Shortly after issuance of this rule, SBA will be providing additional guidance regarding the procedures for lenders and borrowers to use the alcoholism treatment Revenue Reduction Score, including when a score meets or exceeds the value required for validation of the required reductions in gross receipts and thus is considered adequate documentation of the borrower's revenue reduction. 2.

Direct Borrower Forgiveness Process In response to PPP lender and borrower concerns, SBA is implementing a direct borrower forgiveness process. The direct borrower forgiveness process is an optional technology solution that SBA is providing to PPP lenders that will leverage SBA's existing and proven Platform and align with and seamlessly integrate the streamlined forgiveness application for loans of $150,000 or less mandated by the Economic Aid Act. When a PPP lender opts-in to the direct borrower forgiveness process, the Platform will provide a single secure location for all of its borrowers with loans of $150,000 or less to apply for loan forgiveness through the Platform using the electronic equivalent of SBA Form 3508S. Upon receipt of notice that a borrower has applied for forgiveness through the Platform, lenders will review the loan forgiveness application in the Platform and issue a forgiveness decision to SBA inside the Platform. SBA believes that lenders that opt-in to using the direct borrower forgiveness process will benefit with reduced costs, increased efficiency, and more timely remittance of forgiveness payments from SBA, while borrowers will benefit from the ability to submit loan forgiveness applications directly through the Platform and reduce the wait time and uncertainty associated with submission through their lender.

Shortly after issuance of this rule, SBA will be issuing more detailed procedural guidance regarding (1) the process for lenders to opt-in to the direct borrower forgiveness process, (2) the process for borrowers with loans of $150,000 or less to access the Platform and submit their loan forgiveness applications directly through the Platform, and (3) the process for lenders to access the forgiveness applications in the Platform to perform reviews of their borrowers' applications, issue forgiveness decisions to SBA, and request forgiveness payments from SBA. During the transition period after the launch of the direct borrower forgiveness process, lenders that opt-in will be expected to complete the processing of any loan forgiveness applications that have already been submitted by borrowers to the lender and should inform such borrowers not to submit a duplicate loan forgiveness application through the Platform. After the launch of the direct borrower forgiveness process, borrowers will continue to submit loan forgiveness applications to their lenders, rather than through the Platform, under the following circumstances. The PPP lender does not opt-in to use the direct borrower forgiveness process. The borrower's PPP loan amount is greater than $150,000.

The borrower does not agree with the data as provided by the SBA system of record, or cannot validate their identity in the Platform (for example, if there is an unreported change of ownership). Or For any other reason where the Platform rejects the borrower's submission. In such circumstances, borrowers must follow instructions from their lender regarding how the lender expects the borrower to submit a forgiveness application for its PPP loan. B. Deferment Extension for OHA Appeals Currently, the rule for appeals of final SBA loan review decisions on PPP loans provides that because a PPP borrower must begin making payments of principal and interest on the remaining balance of its PPP loan when SBA remits the loan forgiveness amount to the PPP lender (or notifies the lender that no loan forgiveness is allowed), an appeal by a PPP borrower of any final SBA loan review decision does not extend the deferment period of the PPP loan.

SBA is amending the appeals rule to, among other things, provide that a borrower's timely appeal of a final SBA loan review decision will extend the deferment period for the PPP loan until SBA's Office of Hearings and Appeals (OHA) issues a final decision on the appeal. The revised OHA rule will provide that the borrower should notify the lender of the appeal so that the lender can extend the deferment period. Under the revised OHA rule, an appeal petition must be filed with OHA within 30 calendar days after the appellant's receipt of the final SBA loan review decision. SBA has determined that, in order to avoid the potential administrative burden of having to reverse implementation of the final SBA loan review decision, including the refund of borrower payments by the lender and the processing of forgiveness payments by SBA, a timely appeal by a PPP borrower of a final SBA loan review decision should extend the deferment period of the PPP loan. SBA believes Start Printed Page 40925that allowing for continued deferment is in the best interest of the borrower.

For these reasons, SBA is conforming the applicable PPP rules to provide that a timely appeal by a PPP borrower of a final SBA loan review decision extends the deferment period of the PPP loan until OHA's decision becomes final under 13 CFR 134.1211. IV. Revisions to Prior PPP Rules Therefore, the following changes are made to PPP rules. 1st Revision. The first sentence of Part IV.2.a.

Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8287) is revised to read as follows. 2. Loan Forgiveness Process a. What is the general process to obtain loan forgiveness?. To receive loan forgiveness on either a First Draw PPP Loan or a Second Draw PPP Loan, a borrower must complete and submit the Loan Forgiveness Application [] to its lender (or to the lender servicing its loan), or for loans of $150,000 or less if directed by its lender, through the Paycheck Protection Platform (forgiveness.sba.gov).

* * * * * * * * 2nd Revision. Part IV.2.b. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8288) is revised by adding a sentence to the end of the paragraph to read as follows. B. When must a borrower apply for loan forgiveness or start making payments on a loan?.

€‰[] * * * Notwithstanding the foregoing, a borrower's timely appeal of a final SBA loan review decision extends the deferment period on the PPP loan until SBA's Office of Hearings and Appeals issues a final decision on the appeal under 13 CFR 134.1211. 3rd Revision. Part IV.6.a. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8293) is revised by adding a sentence to the end of the first paragraph to read as follows. 6.

Documentation Requirements a. What must borrowers submit for forgiveness of their PPP loans?. * * * If a Second Draw PPP Loan borrower's alcoholism treatment Revenue Reduction Score in the Paycheck Protection Platform meets or exceeds the value required to validate the borrower's revenue reduction, no additional documentation is required to be submitted by the borrower. * * * * * 4th Revision. The first sentence of Part IV.6.b.

Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8293) is revised to read as follows. B. What documentation are borrowers who are individuals with self-employment income who file a Form 1040, Schedule C or F required to submit to their lender with their request for loan forgiveness?. For borrowers that received loans of $150,000 or less that use the SBA Form 3508S, the borrower must submit the certification and information required by section 7A(l)(1)(A) of the Small Business Act and, for a Second Draw PPP Loan, revenue reduction documentation (which could be the alcoholism treatment Revenue Reduction Score, if applicable) if such documentation was not provided at the time of application.[] * * * * * * * * 5th Revision. Part IV.6.c.

Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8293) is revised by adding a sentence to the end of the third paragraph to read as follows. C. What additional documentation must a borrower submit when the President of the United States, Vice President of the United States, the head of an Executive department, or a Member of Congress, or the spouse of any of the preceding, directly or indirectly holds a controlling interest in the borrower?. * * * * * * * * If a borrower with a First Draw PPP Loan of $150,000 or less submits its loan forgiveness application through the Paycheck Protection Platform (Platform), the borrower must submit any required SBA Form 3508D through the Platform not later than 30 days after submitting its application through the Platform. * * * * * 6th Revision.

Footnote 82 in Part V.1.f. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8295) is revised to read as follows. See 85 FR 52833 (Aug. 27, 2020), as amended. 7th Revision.

The SBA Form 3508S subsection of Part V.2.a. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8296) is revised to read as follows. 2. The Loan Forgiveness Process for Lenders a. What should a lender review?.

* * * * * When a borrower submits SBA Form 3508S or lender's equivalent form, the lender shall. I. Confirm receipt of the borrower certifications contained in the SBA Form 3508S or lender's equivalent form. Ii. In the case of a Second Draw PPP Loan of $150,000 or less for which the borrower did not provide documentation of revenue reduction with its application and the lender did not conduct a review of the documentation at the time of application.

If the borrower submits its loan forgiveness application to the lender, the lender may review the borrower's alcoholism treatment Revenue Reduction Score (score) in the Platform to confirm that it meets or exceeds the value required to validate the required reduction in gross receipts. If the borrower's score does not meet or exceed the required value, the lender must confirm the dollar amount and percentage of the borrower's revenue reduction by performing a good faith review, in a reasonable time, of the borrower's calculations and supporting documents concerning the borrower's revenue reduction.[] If the borrower submits its loan forgiveness application through the Paycheck Protection Platform (Platform), the lender must review the borrower's score in the Platform to confirm that it meets or exceeds the value required to validate the required reduction in gross receipts. If the borrower's score does not meet or exceed the required value, the lender must review the revenue reduction documentation uploaded by the borrower into the Platform and confirm the dollar amount and percentage of the borrower's revenue reduction by performing a good faith review, in a reasonable time, of the borrower's calculations and supporting documents concerning the borrower's revenue reduction. For those borrowers that are required to submit documentation regarding revenue reduction (other than a alcoholism treatment Revenue Reduction Score), if the lender identifies errors in the borrower's calculation or material lack of substantiation in the borrower's supporting documents regarding revenue reduction, the lender should work with the borrower to remedy the issue. Providing an accurate calculation Start Printed Page 40926of the loan forgiveness amount is the responsibility of the borrower, and the borrower attests to the accuracy of its reported information and calculations on the Loan Forgiveness Application.

The borrower shall not receive forgiveness without submitting all required documentation to the lender. As the First Interim Final Rule [] and section IV.7 above indicate, lenders may rely on borrower representations. As stated in paragraph III.3.c of the First Interim Final Rule, the lender does not need to independently verify the borrower's reported information if the borrower submits documentation supporting its request for loan forgiveness (if required) and attests that it accurately verified the payments for eligible costs. 8th Revision. The first sentence of the first paragraph of Part V.2.b.

Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8296) is revised to read as follows. B. What is the timeline for the lender's decision on a loan forgiveness application?. The lender must issue a decision to SBA on a loan forgiveness application not later than 60 days after receipt of a complete loan forgiveness application from the borrower or, if applicable, notification by the Paycheck Protection Platform (Platform) that the borrower has submitted a loan forgiveness application into the Platform. * * * * * * * * 9th Revision.

Part III.B.9. Of the Consolidated Eligibility IFR (86 FR 3692, 3703) is revised to add a fourth paragraph at the end that reads as follows. 9. When will I have to begin paying principal and interest on my PPP loan?. * * * * * Notwithstanding the foregoing, a borrower's timely appeal of a final SBA loan review decision extends the deferment period on the PPP loan until SBA's Office of Hearings and Appeals issues a final decision on the appeal under 13 CFR 134.1211.

10th Revision. Part IV.(g)(2)(v) of the Second Draw IFR (86 FR 3712, 3721) is revised to read as follows. (g) How do I submit an application for a Second Draw PPP Loan and what documentation must I provide to demonstrate eligibility?. * * * * * (2) * * * (v) For loans with a principal amount of $150,000 or less, the applicant must submit documentation sufficient to establish that the applicant experienced a reduction in revenue as provided in subsection (c)(1)(i) of this section at the time of application, on or before the date the borrower submits an application for loan forgiveness, or, if the borrower does not apply for loan forgiveness, at SBA's request. Such documentation may include relevant tax forms, including annual tax forms, or, if relevant tax forms are not available, a copy of the applicant's quarterly income statements or bank statements.

A alcoholism treatment Revenue Reduction Score that meets or exceeds the value required to validate the required reduction in gross receipts will be considered adequate documentation of the borrower's revenue reduction. 11th Revision. Part IV.(h)(2)(D) of the Second Draw IFR (86 FR 3712, 3721) is revised to read as follows. (h) What do lenders need to know and do?. (2) * * * (D) For a Second Draw PPP Loan greater than $150,000 or a loan of $150,000 or less where the borrower provides documentation of revenue reduction, confirm the dollar amount and percentage of the borrower's revenue reduction by performing a good faith review, in a reasonable time, of the borrower's calculations and supporting documents concerning the borrower's revenue reduction.

For a loan of $150,000 or less where the borrower does not provide documentation of revenue reduction with its application, the lender shall perform this review when the borrower provides such documentation. If the lender identifies errors in the borrower's calculation or material lack of substantiation in the borrower's supporting documents, the lender should work with the borrower to remedy the issue. For loans of $150,000 or less where the lender elects to use the alcoholism treatment Revenue Reduction Score (score) in the Paycheck Protection Platform (Platform) or where the lender has opted-in to the direct borrower forgiveness process and the borrower submits a loan forgiveness application to the lender through the Platform, the lender must review the borrower's score to confirm that it meets or exceeds the value required to validate the required reduction in gross receipts, otherwise the lender must review the borrower's supporting documentation in accordance with the foregoing requirements. * * * * * 12th Revision. Part IV.(j) of the Second Draw IFR (86 FR 3712, 3722) is revised to read as follows.

(j) Are Second Draw PPP Loans eligible for loan forgiveness?. Second Draw PPP Loans are eligible for loan forgiveness on the same terms and conditions as First Draw PPP Loans, except that Second Draw PPP Loan borrowers with a principal amount of $150,000 or less are required to provide documentation of revenue reduction if such documentation was not provided at the time of the loan application as specified in subsections (g)(2)(iv) and (v) of this section. If a lender elects to use the alcoholism treatment Revenue Reduction Score (score) in the Paycheck Protection Platform (Platform) or where the lender has opted-in to the direct borrower forgiveness process and the borrower submits a loan forgiveness application to the lender through the Platform, a score that meets or exceeds the value required to validate the required reduction in gross receipts will be considered adequate documentation of the borrower's revenue reduction. V. Additional Information SBA may provide further guidance, if needed, through SBA notices that will be posted on SBA's website at www.sba.gov.

Questions on the Paycheck Protection Program may be directed to the Lender Relations Specialist in the local SBA Field Office. The local SBA Field Office may be found at https://www.sba.gov/​tools/​local-assistance/​districtoffices. Compliance With Executive Orders 12866, 12988, 13132 and 13563, the Congressional Review Act, the Administrative Procedure Act, the Paperwork Reduction Act (44 U.S.C. Ch. 35), and the Regulatory Flexibility Act (5 U.S.C.

601-612). Executive Orders 12866 and 13563 OMB's Office of Information and Regulatory Affairs (OIRA) has determined that this interim final rule is economically significant for the purposes of Executive Orders 12866 and 13563. SBA, however, is proceeding under the emergency provision at Executive Order 12866 section 6(a)(3)(D) based on the need to move expeditiously to mitigate the current economic conditions arising from the alcoholism treatment emergency. This rule is necessary to provide economic relief to small businesses and nonprofit organizations nationwide adversely impacted under the alcoholism treatment Emergency Declaration. We anticipate that this rule will result in substantial benefits to small businesses, nonprofit organizations, their employees, and the communities they serve.

However, we lack data to estimate the effects of this rule.Start Printed Page 40927 Congressional Review Act and Administrative Procedure Act OIRA has determined that this is a major rule for purposes of Subtitle E of the Small Business Regulatory Enforcement and Fairness Act of 1996 (also known as the Congressional Review Act or CRA) (5 U.S.C. 804(2) et seq.). Under the CRA, a major rule takes effect 60 days after the rule is published in the Federal Register. 5 U.S.C. 801(a)(3).

Notwithstanding this requirement, the CRA allows agencies to dispense with the requirements of section 801 when the agency for good cause finds that such procedure would be impracticable, unnecessary, or contrary to the public interest and the rule shall take effect at such time as the agency promulgating the rule determines. 5 U.S.C. 808(2). Pursuant to section 808(2), SBA for good cause finds that a 60-day delay to provide public notice is impracticable and contrary to the public interest. Likewise, for the same reasons, SBA for good cause finds that there are grounds to waive the 30-day effective date delay under the Administrative Procedure Act.

5 U.S.C. 553(d)(3). As discussed elsewhere in this interim final rule, given the urgent need to provide borrowers with timely relief and the short period of time before certain borrowers will be required to begin making principal and interest payments if they have not yet applied for forgiveness with their lenders, SBA has determined that it is impractical and not in the public interest to provide a delayed effective date. An immediate effective date will allow SBA to expedite loan forgiveness to small businesses and nonprofit organizations and remit forgiveness payments to lenders. Executive Order 12988 SBA has drafted this rule, to the extent practicable, in accordance with the standards set forth in section 3(a) and 3(b)(2) of Executive Order 12988, to minimize litigation, eliminate ambiguity, and reduce burden.

The rule has no preemptive or retroactive effect. Executive Order 13132 SBA has determined that this rule will not have substantial direct effects on the States, on the relationship between the National Government and the States, or on the distribution of power and responsibilities among the various layers of government. Therefore, SBA has determined that this rule has no federalism implications warranting preparation of a federalism assessment. Paperwork Reduction Act, 44 U.S.C. Chapter 35 SBA has determined that this rule will require revisions to existing recordkeeping or reporting requirements of the Paycheck Protection Program (PPP) information collection, OMB Control Number 3245-0407.

The revisions will affect SBA Forms 3508S and 3508D. SBA Form 3508S will be revised to incorporate the direct borrower forgiveness process and the alcoholism treatment Revenue Reduction Score. SBA Form 3508D will be revised to incorporate the direct borrower forgiveness process. SBA has requested Office of Management and Budget (OMB) emergency approval of the revisions to the information collections to give small businesses and nonprofits affected by this interim final rule the maximum amount of time to apply for loan forgiveness under the new procedures. Regulatory Flexibility Act (RFA) The Regulatory Flexibility Act (RFA) generally requires that when an agency issues a proposed rule, or a final rule pursuant to section 553(b) of the Administrative Procedure Act or another law, the agency must prepare a regulatory flexibility analysis that meets the requirements of the RFA and publish such analysis in the Federal Register.

5 U.S.C. 603, 604. Rules that are exempt from notice and comment are also exempt from the RFA requirements, including conducting a regulatory flexibility analysis, when among other things the agency for good cause finds that notice and public procedure are impracticable, unnecessary, or contrary to the public interest. SBA Office of Advocacy guide. How to Comply with the Regulatory Flexibility Act, Ch.1.

P.9. Since this rule is exempt from notice and comment, SBA is not required to conduct a regulatory flexibility analysis. Start Authority 15 U.S.C. 636(a)(36). 15 U.S.C.

636(a)(37). And 15 U.S.C. 636m. alcoholism Aid, Relief, and Economic Security Act, Pub. L.

116-136, section 1114, and Economic Aid to Hard-Hit Small Businesses, Nonprofits, and Venues Act, Pub. L. 116-260, section 303. End Authority Start Signature Isabella Casillas Guzman, Administrator. End Signature End Supplemental Information [FR Doc.

2021-16358 Filed 7-28-21. 4:15 pm]BILLING CODE 8026-03-PExplore full-page version of the map The number of new alcoholism treatment s has increased significantly for the fourth consecutive week, according to a Daily Yonder analysis. The death rate remained relatively unchanged last week compared to two weeks ago. New s in rural counties climbed 60% last week to a total of 46,141. The rate of new s has more than tripled since the last week of June.

The number of alcoholism treatment-related deaths recorded in rural counties last week declined by 11 to 343. The rate of new s was virtually identical in rural and metropolitan counties last week, 100 new cases per 100,000 in rural counties vs. 104 new cases per 100,000 in metropolitan counties. This week’s analysis covers Sunday, July 15, through Saturday, July 24. The data is from USA Facts.

An Increase in Red-Zone Counties The map above highlights “red-zone” counties – localities where new s total at least 100 new cases for every 100,000 in population over one week. The White House alcoholism Response Group recommends that counties in the red zone take additional steps to contain the antabuse. Like this story?. Sign up for our newsletter. The growth in new s is climbing fastest in the Deep South and in states adjacent to Missouri and Arkansas, the epicenter of the resurgence caused by the delta variant of the alcoholism.Mississippi had a four-fold increase in red-zone counties last week, climbing from 15 to 67.

Forty-one of the new red-zone counties were in rural areas. Nearly 80% of Mississippi’s 65 rural counties are in the red zone. Just one month ago, Mississippi had no red-zone counties.Alabama’s red-zone counties jumped from 20 two weeks ago to 54 last week. Nearly 80% of the state’s 38 rural counties are on the red-zone list.The number of red-zone counties in Texas more than doubled, from 59 two weeks ago to 137 last week.All but one of Arkansas’ 75 counties is in the red zone.Other states seeing significant increases in red-zone counties were Kentucky (from 21 red-zone counties two weeks ago to 56 red-zone counties last week), Kansas (from 30 to 45 red-zone counties), Tennessee (from one to 33 red-zone counties), Oklahoma (from 11 to 32 red-zone counties), and Illinois (from 26 to 39 red-zone counties). Iowa, with Higher Vaccination Rate, Resists Surge To the north of Missouri, Iowa saw a decline in red-zone counties, from 13 two weeks ago to five last week.

In the latest Daily Yonder vaccination analysis, Iowa ranked 15th in its rural vaccination rate (43.8% of the population completely vaccinated). Missouri ranked 42nd (27.7%).Arkansas, where the rate of new rural s doubled last week, ranked 41st for rural vaccinations (29.5%)Other states in the region with below-average rural vaccination rates and large numbers of red-zone counties were Louisiana (27.1% of rural population fully vaccinated), Tennessee (30.6%), Florida (31%), Oklahoma (31.8%), Mississippi (32.2%), Texas (32.2%), Kansas (35.2%). You Might Also Like.

Start Preamble Start Printed order antabuse online canada Page 40921 U.S antabuse buy. Small Business Administration. Interim final antabuse buy rule. This interim final rule implements changes related to the forgiveness of loans made under the Paycheck Protection Program (PPP), which was originally established under the alcoholism Aid, Relief, and Economic Security Act (CARES Act) to provide economic relief to small businesses nationwide adversely impacted by the alcoholism Disease 2019 (alcoholism treatment), as amended. SBA has issued a number of interim final rules implementing the PPP Program.

This interim final rule further streamlines the forgiveness process for PPP loans of $150,000 or less by allowing lenders to use a alcoholism treatment Revenue Reduction Score at the time of forgiveness to document the required revenue reduction for Second Draw PPP Loans, and establishing a direct borrower forgiveness process for lenders that choose to opt-in as an alternative method of processing loan forgiveness applications antabuse buy. This interim final rule also extends the loan deferment period for those PPP loans where the borrower timely files an appeal of a final SBA loan review decision with the SBA Office of Hearings and Appeals. Effective date antabuse buy. The provisions of this interim final rule are effective July 28, 2021. Applicability date.

The alcoholism treatment Revenue Reduction Score portion of this interim final rule applies to all Second Draw PPP Loans for which the lender has not yet issued a loan forgiveness decision to SBA as of the antabuse buy effective date of this rule. The direct borrower forgiveness process portion of this rule applies to all PPP loans for which a loan forgiveness application has not been submitted by the borrower to the lender as of the effective date of this rule. The deferment portion of the rule applies to PPP appeals filed after the effective date of this rule and to those PPP appeals filed before the effective date of this rule for which a Notice and Order has not been issued. Comment antabuse buy date. Comments must be received on or before August 30, 2021.

You may antabuse buy submit comments, identified by docket number SBA-2021-0015 through the Federal eRulemaking Portal. Http://www.regulations.gov. Follow the instructions for submitting comments. SBA will antabuse buy post all comments on www.regulations.gov. If you wish to submit confidential business information (CBI) as defined in the User Notice at www.regulations.gov, please send an email to ppp-ifr@sba.gov.

All other comments must be submitted through the Federal antabuse buy eRulemaking Portal described above. Highlight the information that you consider to be CBI and explain why you believe SBA should hold this information as confidential. SBA will review the information and make the final determination whether it will publish the information. Start Further Info A Call Center Representative at 833-572-0502 or the antabuse buy local SBA Field Office. The list of offices can be found at https://www.sba.gov/​tools/​local-assistance/​districtoffices.

If you use a telecommunications device for the deaf (TDD) or a text telephone (TTY), call the Federal Relay Service (FRS), toll free, at 1-800-877-8339. Individuals with disabilities can obtain this document in antabuse buy an accessible format that may be provided in Rich Text Format (RTF) or text format (txt), a thumb drive, an mp3 file, Braille, large print, audiotape, or compact disc, or other accessible formats. End Further Info End Preamble Start Supplemental Information I. Background Information On March 27, 2020, the alcoholism Aid, Relief, and Economic Security Act (CARES Act) (Pub antabuse buy. L.

116-136) was enacted to provide emergency assistance and health care response for individuals, families, and businesses affected by the alcoholism Disease 2019 (alcoholism treatment) antabuse. Section 1102 of the CARES Act temporarily permitted antabuse buy the Small Business Administration (SBA) to guarantee 100 percent of 7(a) loans under a new program titled the “Paycheck Protection Program,” pursuant to section 7(a)(36) of the Small Business Act (15 U.S.C. 636(a)(36)) (First Draw PPP Loans). Section 1106 of the antabuse buy CARES Act provided for forgiveness of up to the full principal amount of qualifying loans guaranteed under the Paycheck Protection Program (PPP). On April 24, 2020, the Paycheck Protection Program and Health Care Enhancement Act (Pub.

L. 116-139) was enacted, antabuse buy which provided additional funding and authority for the PPP Program. On June 5, the Paycheck Protection Program Flexibility Act of 2020 (PPP Flexibility Act) (Pub. L. 116-142) was enacted, which antabuse buy changed provisions of the PPP relating to the maturity of PPP loans, the deferral of PPP loan payments, and the forgiveness of PPP loans.

On July 4, 2020, Public Law 116-147 extended the authority to guarantee PPP loans to August 8, 2020. On December antabuse buy 27, 2020, the Economic Aid to Hard-Hit Small Businesses, Nonprofits and Venues Act (Economic Aid Act) (Pub. L. 116-260) was enacted. The Economic antabuse buy Aid Act reauthorized lending under the PPP through March 31, 2021.

The Economic Aid Act added a new temporary section 7(a)(37) to the Small Business Act, which authorizes SBA to guarantee additional PPP loans (Second Draw PPP Loans) to certain eligible borrowers that previously received a First Draw PPP Loan under generally the same terms and conditions available under section 7(a)(36) of the Small Business Act. Among other things, antabuse buy to be eligible for a Second Draw PPP Loan, the borrower must have experienced a revenue reduction of not less than 25% in at least one quarter of 2020 compared to the same quarter in 2019. The Economic Aid Act also redesignated section 1106 of the CARES Act as section 7A of the Small Business Act, to appear after section 7 of the Small Business Act. Additionally, the Economic Aid Act provided for a simplified forgiveness application process for PPP loans of $150,000 or less. On March antabuse buy 11, 2021, the American Rescue Plan Act (ARPA) (Pub.

L. 117-2) was enacted, and among other things, expanded eligibility for First Draw PPP Loans and Second Draw PPP Loans and revised exclusions from payroll costs for purposes of forgiveness. On March 30, 2021, the PPP antabuse buy Extension Act of 2021 (Pub. L. 117-6) was enacted, antabuse buy extending SBA's PPP program authority through June 30, 2021.

From April 3, 2020, through August 8, 2020, when the 2020 round of PPP expired, SBA guaranteed over 5.2 million PPP loans made by over 5,000 PPP lenders under delegated authority. From January 11, 2021, when the PPP reopened, through June 30, 2021, when the PPP program authority expired, SBA guaranteed over 6.6 million additional PPP loans. Thus, the total number of PPP loans guaranteed by antabuse buy SBA exceeds 11.8 million.[] The total dollar amount of Start Printed Page 40922the PPP loans guaranteed by SBA exceeds $806 billion. SBA posted the first interim final rule implementing the PPP on SBA's website on April 2, 2020, and published the rule in the Federal Register on April 15, 2020 (85 FR 20811). SBA subsequently antabuse buy issued numerous additional interim final rules.

On June 1, 2020, SBA published an interim final rule on loan forgiveness requirements (85 FR 33004) and an interim final rule on loan review procedures (85 FR 33010). Prior to the publication of the loan forgiveness and loan review interim final rules, on May 15, 2020, SBA issued SBA Form 3508, which was a loan forgiveness application to be used by all PPP borrowers. On June 26, 2020, SBA published an interim final rule revising the loan antabuse buy forgiveness and loan review procedures to conform to the key forgiveness changes made by the PPP Flexibility Act (85 FR 38304). In conjunction with the rule, SBA issued a second loan forgiveness application form, SBA Form 3508EZ, which is a streamlined form that incorporates the forgiveness safe harbors established under the PPP Flexibility Act. SBA's 2020 PPP program authority expired on August 8, 2020.

On August 10, 2020, SBA began accepting PPP lender antabuse buy decisions on PPP borrower loan forgiveness applications through SBA's Paycheck Protection Platform (Platform) (forgiveness.sba.gov). PPP borrowers were required to submit their loan forgiveness applications to their PPP lenders, and as required by section 1106 of the CARES Act (now section 7A of the Small Business Act), lenders were required to issue a decision to SBA on the borrower's loan forgiveness application within 60 days of receipt of the application. On August antabuse buy 27, 2020, SBA issued an interim final rule on Appeals of SBA Loan Review Decisions under the Paycheck Protection Program (85 FR 52883). On October 2, 2020, SBA began remitting forgiveness payments to PPP lenders that submitted forgiveness decisions to SBA through the Platform. SBA continues to remit forgiveness payments to PPP lenders, and as of July 12, 2021, SBA has remitted over 4.3 million forgiveness payments to lenders.[] On October 19, 2020, in response to borrower and lender concerns about the complexity of the loan forgiveness process for the smallest of borrowers, SBA and the Department of the Treasury (Treasury) jointly issued an interim final rule revising the loan forgiveness and loan review procedures to simplify the forgiveness process for PPP loans of $50,000 or less.

Among other things, the rule exempted borrowers with loans of $50,000 or antabuse buy less from the full-time equivalent employee (FTE) and salary/wage reduction penalties included in section 1106 of the CARES Act, under the joint SBA/Treasury statutory authority to make de minimis exemptions to those penalties. In conjunction with the rule, SBA issued a third loan forgiveness application, SBA Form 3508S, which was a further streamlined loan forgiveness application available for use by borrowers with loans of $50,000 or less. On January 14, 2021, SBA published interim final rules implementing the Economic Aid Act amendments to the PPP. The first interim final rule implemented Economic Aid Act changes antabuse buy to, among other things, PPP eligibility, and consolidated numerous prior interim final rules on PPP (86 FR 3692) (Consolidated Eligibility IFR). The second interim final rule implemented the Second Draw PPP Loan program authorized by the Economic Aid Act under section 7(a)(37) of the Small Business Act (86 FR 3712) (Second Draw IFR).

On February 5, 2021, SBA published a third interim final rule implementing Economic Aid Act changes related to the antabuse buy forgiveness and review of PPP loans (86 FR 8283) (Consolidated Forgiveness and Loan Review IFR). Among other things, the Consolidated Forgiveness and Loan Review IFR implemented the simplified forgiveness application process for loans of $150,000 or less required by the Economic Aid Act. In conjunction with this rule, on January 19, 2021, SBA issued a revised SBA Form 3508S, which increased the loan amount for which the form could be used from $50,000 to $150,000.[] The new SBA Form 3508S was also shortened to one page, as required by the Economic Aid Act, and no longer requires the submission of supporting forgiveness documentation, as mandated by the Economic Aid Act. Following the publication of the interim final rules implementing the Economic Aid antabuse buy Act, SBA published another interim final rule on March 8, 2021, revising certain loan amount calculation and eligibility provisions for PPP (86 FR 13149). On March 22, 2021, SBA published an interim final rule implementing the PPP provisions of ARPA (86 FR 15083).

As described below, this interim final rule further streamlines the forgiveness process for PPP loans of $150,000 or less by (a) allowing lenders to use a alcoholism treatment Revenue Reduction Score at the antabuse buy time of loan forgiveness to document the required revenue reduction for Second Draw PPP loans of $150,000 or less, and (b) establishing a direct borrower forgiveness process for lenders that choose to opt-in as an alternative method of processing loan forgiveness applications for PPP Loans of $150,000 or less. This interim final rule also extends the loan deferment period for those PPP loans where the borrower timely files an appeal of a final SBA loan review decision with the SBA Office of Hearings and Appeals. II. Comments and Immediate Effective Date This interim final rule is being issued without advance antabuse buy notice and public comment because section 1114 of the CARES Act and section 303 of the Economic Aid Act authorize SBA to issue regulations to implement the Paycheck Protection Program without regard to notice requirements. Even otherwise, SBA finds good cause for setting aside the advance notice-and-public-comment procedure because that procedure would be impracticable and contrary to the public interest.

The intent of the CARES Act and the Economic Aid Act is to afford SBA the flexibility to provide relief to America's small businesses and nonprofit organizations expeditiously. Given the urgent need to provide borrowers with timely relief, the purpose of the rule is to antabuse buy minimize the burdens of the current loan forgiveness process that, without modification, could result in borrowers unnecessarily having to make principal and interest payments on loans that should be forgiven. If SBA were to follow the advance notice-and-public-comment process, that would delay issuance of the rule by at least three months. SBA understands—based on its antabuse buy expertise and consistent portfolio analysis—that a significant number of borrowers will have to apply for loan forgiveness in the next three months. Therefore, if the proposed rule is still undergoing notice and comment during that time, these borrowers will be applying under the current process, which (as noted above) would mean these borrowers could unnecessarily have to make principal and interest payments on loans that should be forgiven and would not be positively Start Printed Page 40923impacted by a later rule change.

Providing for notice and comment would render the rule effectively moot and useless for millions of intended beneficiaries. For these same reasons, SBA has determined that it is impractical and not in the public antabuse buy interest to provide a 30-day delayed effective date. An immediate effective date will allow SBA to expedite loan forgiveness to small businesses and nonprofit organizations and remit forgiveness payments to lenders. This good cause justification also supports waiver of the 60-day delayed effective date for major rules under Subtitle E of the Small Business Regulatory Enforcement Fairness Act of 1996 (also known as antabuse buy the Congressional Review Act) at 5 U.S.C. 808(2).

Although this interim final rule is effective immediately, comments are solicited from interested members of the public on all aspects of the interim final rule. These comments must be submitted on antabuse buy or before August 30, 2021. SBA will consider these comments and the need for making any revisions as a result of these comments. III. Paycheck Protection Program—alcoholism treatment Revenue Reduction Score, Direct Borrower Forgiveness Process, and antabuse buy Appeals Deferment Overview A.

Further Streamlining Forgiveness for PPP Loans of $150,000 or Less A key feature of the PPP is that a borrower may obtain forgiveness of up to the full amount of its PPP loan provided that the borrower complied with PPP requirements. Since SBA issued the first loan forgiveness application form (SBA Form 3508) in May 2020 and published the first loan forgiveness and loan review rules in June 2020, SBA antabuse buy has received comments from borrowers and lenders that the loan forgiveness process is overwhelming and difficult to manage and requesting simplification of the process. In response to borrower and lender requests for simplification of the loan forgiveness process, Congress enacted the PPP Flexibility Act in June 2020, which created safe harbors from the FTE and salary/wage reduction penalties of section 1106 of the CARES Act, and in response, SBA issued a new streamlined loan forgiveness application (SBA Form 3508EZ) implementing those changes. In October 2020, SBA and Treasury exempted borrowers with loans of $50,000 or less from the FTE and salary/wage reduction penalties and issued a second new streamlined loan forgiveness application (SBA Form 3508S) implementing those changes. Borrowers and lenders continued to express concerns about the complexity of the loan forgiveness process, and in December 2020, Congress enacted the Economic Aid Act, which provides for a simplified loan forgiveness application process for borrowers with loans antabuse buy of $150,000 or less.

SBA implemented this requirement by revising the second streamlined loan forgiveness application (SBA Form 3508S) to allow all borrowers with loans of $150,000 or less to use the form. Loans of $150,000 or less represent 93 percent of the outstanding PPP loans antabuse buy. Despite the implementation of the streamlined loan forgiveness application for borrowers with loans of $150,000 or less, many smaller PPP lenders continue to express concerns to SBA that they do not have the technology or human resources to develop efficient electronic loan forgiveness platforms to process the new streamlined loan forgiveness application.[] SBA has also become aware that because lenders are overwhelmed by the volume of PPP loans and are mindful of the statutory 60-day requirement for lenders to issue a forgiveness decision to SBA from receipt of the borrower's loan forgiveness application, lenders are limiting when loan forgiveness applications are accepted from borrowers, creating uncertainty among borrowers that they are going to have to start making payments on their PPP loans while they are waiting for their lenders to accept and process their loan forgiveness applications. Additionally, SBA has heard concerns from PPP lenders of all sizes that the requirement for borrowers to submit and lenders to review at the time of forgiveness the revenue reduction documentation for Second Draw PPP Loans of $150,000 or less is delaying the forgiveness process for these borrowers. To further simplify and antabuse buy streamline the forgiveness process for loans $150,000 or less, SBA is making two changes under this interim final rule.

First, for Second Draw PPP Loans of $150,000 or less, where the borrower is required to provide revenue reduction documentation at the time of loan forgiveness, SBA is allowing lenders to use a alcoholism treatment Revenue Reduction Score developed by SBA's contractor as an optional method to document the borrower's revenue reduction. Second, SBA is making available a direct borrower forgiveness process for lenders that choose to opt-in as an alternative method for processing borrower loan forgiveness applications for all PPP loans of $150,000 or less. 1. alcoholism treatment Revenue Reduction Score Among other things, to be eligible for a Second Draw PPP Loan, a PPP borrower is required to have experienced a revenue reduction of not less than 25% during one quarter of 2020 compared to the same quarter in 2019. Under section 7(a)(37)(I) of the Small Business Act, when a borrower applies for a Second Draw PPP Loan of $150,000 or less, the borrower can submit a certification that the borrower meets the revenue reduction standard, provided that on or before the date on which the borrower submits an application for loan forgiveness, the borrower produces adequate documentation that the borrower has met the revenue reduction standard.

All Second Draw PPP Loan borrowers were required to certify on their loan applications (SBA Forms 2483-SD and 2483-SD-C) that they realized a reduction in gross receipts in excess of 25% relative to the relevant comparison time period. The Second Draw PPP Loan IFR and the Loan Forgiveness and Loan Review IFR implementing the Economic Aid Act provide that if a borrower with a Second Draw PPP Loan of $150,000 or less did not produce documentation of revenue reduction at the time of application, the borrower must, on or before the date the borrower applies for loan forgiveness, submit to the lender documentation adequate to establish that the borrower experienced a revenue reduction of 25% or greater in 2020 relative to 2019, and such documentation may include relevant tax forms, including annual tax forms, or if relevant tax forms are not available, quarterly financial statements or bank statements. The rules also provide that where a borrower with a Second Draw PPP Loan of $150,000 or less does not provide documentation of revenue reduction with its loan application, the lender must perform a good faith review of the documents provided by the borrower at or before forgiveness, including the borrower's calculations and supporting documents.[] Start Printed Page 40924 To streamline forgiveness of Second Draw PPP Loans of $150,000 or less where the borrower did not submit documentation of revenue reduction at the time of the loan application, SBA has determined that an alternative form of revenue reduction confirmation is warranted to document the borrower's revenue reduction. An independent third-party SBA contractor has developed a alcoholism treatment Revenue Reduction Score (score) based on a variety of inputs including industry, geography, and business size. The score uses current data on economic recovery and return of businesses to operational status.[] Each Second Draw PPP Loan of $150,000 or less will be assigned a score, which will be maintained in the Platform and will be visible to lenders to use on an optional basis as an alternative to document revenue reduction.

Additionally, the score will be visible to those borrowers that submit their loan forgiveness applications through the Platform using the direct borrower forgiveness process. When the score meets or exceeds the value required for validation of the borrower's revenue reduction, use of the score will satisfy the requirement for the borrower to document revenue reduction. When the score does not meet the value required for validation of the borrower's revenue reduction, and if the borrower has not already provided documentation to the lender that validates the borrower's revenue reduction, the borrower must provide documentation either directly to the lender (for those lenders that do not opt-in to the direct borrower forgiveness process) or provide documentation to the lender by uploading it to the Platform. Shortly after issuance of this rule, SBA will be providing additional guidance regarding the procedures for lenders and borrowers to use the alcoholism treatment Revenue Reduction Score, including when a score meets or exceeds the value required for validation of the required reductions in gross receipts and thus is considered adequate documentation of the borrower's revenue reduction. 2.

Direct Borrower Forgiveness Process In response to PPP lender and borrower concerns, SBA is implementing a direct borrower forgiveness process. The direct borrower forgiveness process is an optional technology solution that SBA is providing to PPP lenders that will leverage SBA's existing and proven Platform and align with and seamlessly integrate the streamlined forgiveness application for loans of $150,000 or less mandated by the Economic Aid Act. When a PPP lender opts-in to the direct borrower forgiveness process, the Platform will provide a single secure location for all of its borrowers with loans of $150,000 or less to apply for loan forgiveness through the Platform using the electronic equivalent of SBA Form 3508S. Upon receipt of notice that a borrower has applied for forgiveness through the Platform, lenders will review the loan forgiveness application in the Platform and issue a forgiveness decision to SBA inside the Platform. SBA believes that lenders that opt-in to using the direct borrower forgiveness process will benefit with reduced costs, increased efficiency, and more timely remittance of forgiveness payments from SBA, while borrowers will benefit from the ability to submit loan forgiveness applications directly through the Platform and reduce the wait time and uncertainty associated with submission through their lender.

Shortly after issuance of this rule, SBA will be issuing more detailed procedural guidance regarding (1) the process for lenders to opt-in to the direct borrower forgiveness process, (2) the process for borrowers with loans of $150,000 or less to access the Platform and submit their loan forgiveness applications directly through the Platform, and (3) the process for lenders to access the forgiveness applications in the Platform to perform reviews of their borrowers' applications, issue forgiveness decisions to SBA, and request forgiveness payments from SBA. During the transition period after the launch of the direct borrower forgiveness process, lenders that opt-in will be expected to complete the processing of any loan forgiveness applications that have already been submitted by borrowers to the lender and should inform such borrowers not to submit a duplicate loan forgiveness application through the Platform. After the launch of the direct borrower forgiveness process, borrowers will continue to submit loan forgiveness applications to their lenders, rather than through the Platform, under the following circumstances. The PPP lender does not opt-in to use the direct borrower forgiveness process. The borrower's PPP loan amount is greater than $150,000.

The borrower does not agree with the data as provided by the SBA system of record, or cannot validate their identity in the Platform (for example, if there is an unreported change of ownership). Or For any other reason where the Platform rejects the borrower's submission. In such circumstances, borrowers must follow instructions from their lender regarding how the lender expects the borrower to submit a forgiveness application for its PPP loan. B. Deferment Extension for OHA Appeals Currently, the rule for appeals of final SBA loan review decisions on PPP loans provides that because a PPP borrower must begin making payments of principal and interest on the remaining balance of its PPP loan when SBA remits the loan forgiveness amount to the PPP lender (or notifies the lender that no loan forgiveness is allowed), an appeal by a PPP borrower of any final SBA loan review decision does not extend the deferment period of the PPP loan.

SBA is amending the appeals rule to, among other things, provide that a borrower's timely appeal of a final SBA loan review decision will extend the deferment period for the PPP loan until SBA's Office of Hearings and Appeals (OHA) issues a final decision on the appeal. The revised OHA rule will provide that the borrower should notify the lender of the appeal so that the lender can extend the deferment period. Under the revised OHA rule, an appeal petition must be filed with OHA within 30 calendar days after the appellant's receipt of the final SBA loan review decision. SBA has determined that, in order to avoid the potential administrative burden of having to reverse implementation of the final SBA loan review decision, including the refund of borrower payments by the lender and the processing of forgiveness payments by SBA, a timely appeal by a PPP borrower of a final SBA loan review decision should extend the deferment period of the PPP loan. SBA believes Start Printed Page 40925that allowing for continued deferment is in the best interest of the borrower.

For these reasons, SBA is conforming the applicable PPP rules to provide that a timely appeal by a PPP borrower of a final SBA loan review decision extends the deferment period of the PPP loan until OHA's decision becomes final under 13 CFR 134.1211. IV. Revisions to Prior PPP Rules Therefore, the following changes are made to PPP rules. 1st Revision. The first sentence of Part IV.2.a.

Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8287) is revised to read as follows. 2. Loan Forgiveness Process a. What is the general process to obtain loan forgiveness?. To receive loan forgiveness on either a First Draw PPP Loan or a Second Draw PPP Loan, a borrower must complete and submit the Loan Forgiveness Application [] to its lender (or to the lender servicing its loan), or for loans of $150,000 or less if directed by its lender, through the Paycheck Protection Platform (forgiveness.sba.gov).

* * * * * * * * 2nd Revision. Part IV.2.b. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8288) is revised by adding a sentence to the end of the paragraph to read as follows. B. When must a borrower apply for loan forgiveness or start making payments on a loan?.

€‰[] * * * Notwithstanding the foregoing, a borrower's timely appeal of a final SBA loan review decision extends the deferment period on the PPP loan until SBA's Office of Hearings and Appeals issues a final decision on the appeal under 13 CFR 134.1211. 3rd Revision. Part IV.6.a. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8293) is revised by adding a sentence to the end of the first paragraph to read as follows. 6.

Documentation Requirements a. What must borrowers submit for forgiveness of their PPP loans?. * * * If a Second Draw PPP Loan borrower's alcoholism treatment Revenue Reduction Score in the Paycheck Protection Platform meets or exceeds the value required to validate the borrower's revenue reduction, no additional documentation is required to be submitted by the borrower. * * * * * 4th Revision. The first sentence of Part IV.6.b.

Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8293) is revised to read as follows. B. What documentation are borrowers who are individuals with self-employment income who file a Form 1040, Schedule C or F required to submit to their lender with their request for loan forgiveness?. For borrowers that received loans of $150,000 or less that use the SBA Form 3508S, the borrower must submit the certification and information required by section 7A(l)(1)(A) of the Small Business Act and, for a Second Draw PPP Loan, revenue reduction documentation (which could be the alcoholism treatment Revenue Reduction Score, if applicable) if such documentation was not provided at the time of application.[] * * * * * * * * 5th Revision. Part IV.6.c.

Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8293) is revised by adding a sentence to the end of the third paragraph to read as follows. C. What additional documentation must a borrower submit when the President of the United States, Vice President of the United States, the head of an Executive department, or a Member of Congress, or the spouse of any of the preceding, directly or indirectly holds a controlling interest in the borrower?. * * * * * * * * If a borrower with a First Draw PPP Loan of $150,000 or less submits its loan forgiveness application through the Paycheck Protection Platform (Platform), the borrower must submit any required SBA Form 3508D through the Platform not later than 30 days after submitting its application through the Platform. * * * * * 6th Revision.

Footnote 82 in Part V.1.f. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8295) is revised to read as follows. See 85 FR 52833 (Aug. 27, 2020), as amended. 7th Revision.

The SBA Form 3508S subsection of Part V.2.a. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8296) is revised to read as follows. 2. The Loan Forgiveness Process for Lenders a. What should a lender review?.

* * * * * When a borrower submits SBA Form 3508S or lender's equivalent form, the lender shall. I. Confirm receipt of the borrower certifications contained in the SBA Form 3508S or lender's equivalent form. Ii. In the case of a Second Draw PPP Loan of $150,000 or less for which the borrower did not provide documentation of revenue reduction with its application and the lender did not conduct a review of the documentation at the time of application.

If the borrower submits its loan forgiveness application to the lender, the lender may review the borrower's alcoholism treatment Revenue Reduction Score (score) in the Platform to confirm that it meets or exceeds the value required to validate the required reduction in gross receipts. If the borrower's score does not meet or exceed the required value, the lender must confirm the dollar amount and percentage of the borrower's revenue reduction by performing a good faith review, in a reasonable time, of the borrower's calculations and supporting documents concerning the borrower's revenue reduction.[] If the borrower submits its loan forgiveness application through the Paycheck Protection Platform (Platform), the lender must review the borrower's score in the Platform to confirm that it meets or exceeds the value required to validate the required reduction in gross receipts. If the borrower's score does not meet or exceed the required value, the lender must review the revenue reduction documentation uploaded by the borrower into the Platform and confirm the dollar amount and percentage of the borrower's revenue reduction by performing a good faith review, in a reasonable time, of the borrower's calculations and supporting documents concerning the borrower's revenue reduction. For those borrowers that are required to submit documentation regarding revenue reduction (other than a alcoholism treatment Revenue Reduction Score), if the lender identifies errors in the borrower's calculation or material lack of substantiation in the borrower's supporting documents regarding revenue reduction, the lender should work with the borrower to remedy the issue. Providing an accurate calculation Start Printed Page 40926of the loan forgiveness amount is the responsibility of the borrower, and the borrower attests to the accuracy of its reported information and calculations on the Loan Forgiveness Application.

The borrower shall not receive forgiveness without submitting all required documentation to the lender. As the First Interim Final Rule [] and section IV.7 above indicate, lenders may rely on borrower representations. As stated in paragraph III.3.c of the First Interim Final Rule, the lender does not need to independently verify the borrower's reported information if the borrower submits documentation supporting its request for loan forgiveness (if required) and attests that it accurately verified the payments for eligible costs. 8th Revision. The first sentence of the first paragraph of Part V.2.b.

Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8296) is revised to read as follows. B. What is the timeline for the lender's decision on a loan forgiveness application?. The lender must issue a decision to SBA on a loan forgiveness application not later than 60 days after receipt of a complete loan forgiveness application from the borrower or, if applicable, notification by the Paycheck Protection Platform (Platform) that the borrower has submitted a loan forgiveness application into the Platform. * * * * * * * * 9th Revision.

Part III.B.9. Of the Consolidated Eligibility IFR (86 FR 3692, 3703) is revised to add a fourth paragraph at the end that reads as follows. 9. When will I have to begin paying principal and interest on my PPP loan?. * * * * * Notwithstanding the foregoing, a borrower's timely appeal of a final SBA loan review decision extends the deferment period on the PPP loan until SBA's Office of Hearings and Appeals issues a final decision on the appeal under 13 CFR 134.1211.

10th Revision. Part IV.(g)(2)(v) of the Second Draw IFR (86 FR 3712, 3721) is revised to read as follows. (g) How do I submit an application for a Second Draw PPP Loan and what documentation must I provide to demonstrate eligibility?. * * * * * (2) * * * (v) For loans with a principal amount of $150,000 or less, the applicant must submit documentation sufficient to establish that the applicant experienced a reduction in revenue as provided in subsection (c)(1)(i) of this section at the time of application, on or before the date the borrower submits an application for loan forgiveness, or, if the borrower does not apply for loan forgiveness, at SBA's request. Such documentation may include relevant tax forms, including annual tax forms, or, if relevant tax forms are not available, a copy of the applicant's quarterly income statements or bank statements.

A alcoholism treatment Revenue Reduction Score that meets or exceeds the value required to validate the required reduction in gross receipts will be considered adequate documentation of the borrower's revenue reduction. 11th Revision. Part IV.(h)(2)(D) of the Second Draw IFR (86 FR 3712, 3721) is revised to read as follows. (h) What do lenders need to know and do?. (2) * * * (D) For a Second Draw PPP Loan greater than $150,000 or a loan of $150,000 or less where the borrower provides documentation of revenue reduction, confirm the dollar amount and percentage of the borrower's revenue reduction by performing a good faith review, in a reasonable time, of the borrower's calculations and supporting documents concerning the borrower's revenue reduction.

For a loan of $150,000 or less where the borrower does not provide documentation of revenue reduction with its application, the lender shall perform this review when the borrower provides such documentation. If the lender identifies errors in the borrower's calculation or material lack of substantiation in the borrower's supporting documents, the lender should work with the borrower to remedy the issue. For loans of $150,000 or less where the lender elects to use the alcoholism treatment Revenue Reduction Score (score) in the Paycheck Protection Platform (Platform) or where the lender has opted-in to the direct borrower forgiveness process and the borrower submits a loan forgiveness application to the lender through the Platform, the lender must review the borrower's score to confirm that it meets or exceeds the value required to validate the required reduction in gross receipts, otherwise the lender must review the borrower's supporting documentation in accordance with the foregoing requirements. * * * * * 12th Revision. Part IV.(j) of the Second Draw IFR (86 FR 3712, 3722) is revised to read as follows.

(j) Are Second Draw PPP Loans eligible for loan forgiveness?. Second Draw PPP Loans are eligible for loan forgiveness on the same terms and conditions as First Draw PPP Loans, except that Second Draw PPP Loan borrowers with a principal amount of $150,000 or less are required to provide documentation of revenue reduction if such documentation was not provided at the time of the loan application as specified in subsections (g)(2)(iv) and (v) of this section. If a lender elects to use the alcoholism treatment Revenue Reduction Score (score) in the Paycheck Protection Platform (Platform) or where the lender has opted-in to the direct borrower forgiveness process and the borrower submits a loan forgiveness application to the lender through the Platform, a score that meets or exceeds the value required to validate the required reduction in gross receipts will be considered adequate documentation of the borrower's revenue reduction. V. Additional Information SBA may provide further guidance, if needed, through SBA notices that will be posted on SBA's website at www.sba.gov.

Questions on the Paycheck Protection Program may be directed to the Lender Relations Specialist in the local SBA Field Office. The local SBA Field Office may be found at https://www.sba.gov/​tools/​local-assistance/​districtoffices. Compliance With Executive Orders 12866, 12988, 13132 and 13563, the Congressional Review Act, the Administrative Procedure Act, the Paperwork Reduction Act (44 U.S.C. Ch. 35), and the Regulatory Flexibility Act (5 U.S.C.

601-612). Executive Orders 12866 and 13563 OMB's Office of Information and Regulatory Affairs (OIRA) has determined that this interim final rule is economically significant for the purposes of Executive Orders 12866 and 13563. SBA, however, is proceeding under the emergency provision at Executive Order 12866 section 6(a)(3)(D) based on the need to move expeditiously to mitigate the current economic conditions arising from the alcoholism treatment emergency. This rule is necessary to provide economic relief to small businesses and nonprofit organizations nationwide adversely impacted under the alcoholism treatment Emergency Declaration. We anticipate that this rule will result in substantial benefits to small businesses, nonprofit organizations, their employees, and the communities they serve.

However, we lack data to estimate the effects of this rule.Start Printed Page 40927 Congressional Review Act and Administrative Procedure Act OIRA has determined that this is a major rule for purposes of Subtitle E of the Small Business Regulatory Enforcement and Fairness Act of 1996 (also known as the Congressional Review Act or CRA) (5 U.S.C. 804(2) et seq.). Under the CRA, a major rule takes effect 60 days after the rule is published in the Federal Register. 5 U.S.C. 801(a)(3).

Notwithstanding this requirement, the CRA allows agencies to dispense with the requirements of section 801 when the agency for good cause finds that such procedure would be impracticable, unnecessary, or contrary to the public interest and the rule shall take effect at such time as the agency promulgating the rule determines. 5 U.S.C. 808(2). Pursuant to section 808(2), SBA for good cause finds that a 60-day delay to provide public notice is impracticable and contrary to the public interest. Likewise, for the same reasons, SBA for good cause finds that there are grounds to waive the 30-day effective date delay under the Administrative Procedure Act.

5 U.S.C. 553(d)(3). As discussed elsewhere in this interim final rule, given the urgent need to provide borrowers with timely relief and the short period of time before certain borrowers will be required to begin making principal and interest payments if they have not yet applied for forgiveness with their lenders, SBA has determined that it is impractical and not in the public interest to provide a delayed effective date. An immediate effective date will allow SBA to expedite loan forgiveness to small businesses and nonprofit organizations and remit forgiveness payments to lenders. Executive Order 12988 SBA has drafted this rule, to the extent practicable, in accordance with the standards set forth in section 3(a) and 3(b)(2) of Executive Order 12988, to minimize litigation, eliminate ambiguity, and reduce burden.

The rule has no preemptive or retroactive effect. Executive Order 13132 SBA has determined that this rule will not have substantial direct effects on the States, on the relationship between the National Government and the States, or on the distribution of power and responsibilities among the various layers of government. Therefore, SBA has determined that this rule has no federalism implications warranting preparation of a federalism assessment. Paperwork Reduction Act, 44 U.S.C. Chapter 35 SBA has determined that this rule will require revisions to existing recordkeeping or reporting requirements of the Paycheck Protection Program (PPP) information collection, OMB Control Number 3245-0407.

The revisions will affect SBA Forms 3508S and 3508D. SBA Form 3508S will be revised to incorporate the direct borrower forgiveness process and the alcoholism treatment Revenue Reduction Score. SBA Form 3508D will be revised to incorporate the direct borrower forgiveness process. SBA has requested Office of Management and Budget (OMB) emergency approval of the revisions to the information collections to give small businesses and nonprofits affected by this interim final rule the maximum amount of time to apply for loan forgiveness under the new procedures. Regulatory Flexibility Act (RFA) The Regulatory Flexibility Act (RFA) generally requires that when an agency issues a proposed rule, or a final rule pursuant to section 553(b) of the Administrative Procedure Act or another law, the agency must prepare a regulatory flexibility analysis that meets the requirements of the RFA and publish such analysis in the Federal Register.

5 U.S.C. 603, 604. Rules that are exempt from notice and comment are also exempt from the RFA requirements, including conducting a regulatory flexibility analysis, when among other things the agency for good cause finds that notice and public procedure are impracticable, unnecessary, or contrary to the public interest. SBA Office of Advocacy guide. How to Comply with the Regulatory Flexibility Act, Ch.1.

P.9. Since this rule is exempt from notice and comment, SBA is not required to conduct a regulatory flexibility analysis. Start Authority 15 U.S.C. 636(a)(36). 15 U.S.C.

636(a)(37). And 15 U.S.C. 636m. alcoholism Aid, Relief, and Economic Security Act, Pub. L.

116-136, section 1114, and Economic Aid to Hard-Hit Small Businesses, Nonprofits, and Venues Act, Pub. L. 116-260, section 303. End Authority Start Signature Isabella Casillas Guzman, Administrator. End Signature End Supplemental Information [FR Doc.

2021-16358 Filed 7-28-21. 4:15 pm]BILLING CODE 8026-03-PExplore full-page version of the map The number of new alcoholism treatment s has increased significantly for the fourth consecutive week, according to a Daily Yonder analysis. The death rate remained relatively unchanged last week compared to two weeks ago. New s in rural counties climbed 60% last week to a total of 46,141. The rate of new s has more than tripled since the last week of June.

The number of alcoholism treatment-related deaths recorded in rural counties last week declined by 11 to 343. The rate of new s was virtually identical in rural and metropolitan counties last week, 100 new cases per 100,000 in rural counties vs. 104 new cases per 100,000 in metropolitan counties. This week’s analysis covers Sunday, July 15, through Saturday, July 24. The data is from USA Facts.

An Increase in Red-Zone Counties The map above highlights “red-zone” counties – localities where new s total at least 100 new cases for every 100,000 in population over one week. The White House alcoholism Response Group recommends that counties in the red zone take additional steps to contain the antabuse. Like this story?. Sign up for our newsletter. The growth in new s is climbing fastest in the Deep South and in states adjacent to Missouri and Arkansas, the epicenter of the resurgence caused by the delta variant of the alcoholism.Mississippi had a four-fold increase in red-zone counties last week, climbing from 15 to 67.

Forty-one of the new red-zone counties were in rural areas. Nearly 80% of Mississippi’s 65 rural counties are in the red zone. Just one month ago, Mississippi had no red-zone counties.Alabama’s red-zone counties jumped from 20 two weeks ago to 54 last week. Nearly 80% of the state’s 38 rural counties are on the red-zone list.The number of red-zone counties in Texas more than doubled, from 59 two weeks ago to 137 last week.All but one of Arkansas’ 75 counties is in the red zone.Other states seeing significant increases in red-zone counties were Kentucky (from 21 red-zone counties two weeks ago to 56 red-zone counties last week), Kansas (from 30 to 45 red-zone counties), Tennessee (from one to 33 red-zone counties), Oklahoma (from 11 to 32 red-zone counties), and Illinois (from 26 to 39 red-zone counties). Iowa, with Higher Vaccination Rate, Resists Surge To the north of Missouri, Iowa saw a decline in red-zone counties, from 13 two weeks ago to five last week.

In the latest Daily Yonder vaccination analysis, Iowa ranked 15th in its rural vaccination rate (43.8% of the population completely vaccinated). Missouri ranked 42nd (27.7%).Arkansas, where the rate of new rural s doubled last week, ranked 41st for rural vaccinations (29.5%)Other states in the region with below-average rural vaccination rates and large numbers of red-zone counties were Louisiana (27.1% of rural population fully vaccinated), Tennessee (30.6%), Florida (31%), Oklahoma (31.8%), Mississippi (32.2%), Texas (32.2%), Kansas (35.2%). You Might Also Like.