Get Change Information Form - Acumen Fiscal Agent

This guide provides clear instructions on how to effectively complete the Change Information Form for Acumen Fiscal Agent online. Users will benefit from step-by-step guidance on each section and field of the form, ensuring that all necessary information is accurately submitted.

Follow the steps to complete your Change Information Form successfully.

1. Press the 'Get Form' button to access the Change Information Form online.
2. Begin with the 'Change Employee Information' section. Here you will enter any updated details regarding the employee providing services. Indicate what has changed by checking the appropriate boxes and fill in the previous and new information, including their street address, city, state, zip code, phone number, and the last four digits of their Social Security number for verification.
3. Sign and date the authorized signature section for the employee information change before proceeding.
4. Next, move to the 'Change Information for Person Served' section. Similar to the previous section, check what has changed and fill in both previous and new details for the person receiving services. Be sure to include their street address, city, state, zip code, phone number, and the last four digits of their Social Security number.
5. Again, sign and date the authorized signature section for the person served change.
6. Finally, go to the 'Change Information for Employer or Authorized Representative' section. Specify what has changed in this section by checking the relevant boxes. Provide both previous and new details for the employer, including their street address, city, state, zip code, phone number, and the last four digits of their Social Security number.
7. After filling in the necessary information, sign and date the authorized signature section for the employer change.
8. Once all sections are completed, you can save your changes, download the form, print it, or share it as needed. Ensure that you send the completed form along with any required documentation via fax, email, or mail to Acumen.

Complete your Change Information Form online today for a smooth submission process.