Department Name Title Ext Phone

Found 6 free book(s)

Employee Information

www.bls.gov

Emergency Information US Department of Labor We need to know who to contact in case of an emergency Instructions -please print or type the requested information.-Complete Employee Information section-Provide name, address and phone number for two emergency contacts Under Contact Information.

Department, Name, Phone

CANCELLATION REQUEST / POLICY RELEASE DATE …

bsrinsurance.com

phone (a/c, no, ext): cancelled policy information policy release statement for agency/company use method of cancellation name and address request/release distribution acord 35 (1/97) date (mm/dd/yy) producer code: sub code: agency customer id: company name and address naic code: policy type insured name and address policy number effective date and

Name, Phone

W-12 IRS Paid Preparer Tax Identification Number (PTIN)

www.irs.gov

Phone Number. Business address Check here if your business address is the same as your personal mailing address. If different, enter it below. City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country. Domestic business phone number ( ) - EXT. International business phone number + b Business

Name, Phone

State of North Carolina

www.sosnc.gov

Change/Update Other Contact Information (e-mail, phone numbers, employer, etc.) Change of Name and Address with New County (DO NOT USE THIS FORM. If both name d cou tyare being changed at the same time, use the Application for Reappointment Form) 1. New Full Legal Name: (First, Middle/Maiden, Last – including changes) Male Female 2.

States, Name, Carolina, North, Phone, State of north carolina

Verify New York State Licensure (Certification)

www.op.nysed.gov

518-474-3817 Ext. 1-390. There is an additional fee per request.€ Mail this form and fee to: New York State Education Department, Office of the Professions, Certification and Verification Unit, 89 Washington Avenue,

York, Department, Education, States, New york state education department

February 1, 2022

www.cms.gov

Phone: 1-888-866-6205 Once MAXIMUS receives a referral for an NSA compliance matter, MAXIMUS will contact the consumer and other parties involved to obtain any relevant information in order to complete the external review process. MOVEit REGISTRATION: In order for a state to submit an NSA referral via MOVEit, it will need to create an account or

Phone