For questions related to this policy or assistance with completing the form, please contact AKH at [email protected]. Once the form and payment have been submitted, your credits will be reported to CPE Monitor within 30 days. ACPE now charges all providers an administrative fee for submitting credits after the assigned deadline. Unfortunately, AKH must pass this cost on to participants who claim credit late. The late submission fee is $200 payable to ACPE, plus a $25 processing fee to AKH, for a total of $225. Name * Title of activity: * Date of activity * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20212022202320242025202620272028 NABP ePID Number * Date of Birth (mmdd - example 0512) * Please indicate the UAN number and/or title and date of activity for which you are seeking credit. * Are you claiming maximum or partial credit? * Maximum Partial Email * By checking here I agree to pay the total amount listed above. * Yes Leave this field blank
