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Get Notice Of Appointment Of Authorized Agent Or Contact - Nd
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How to use or fill out the NOTICE OF APPOINTMENT OF AUTHORIZED AGENT OR CONTACT - Nd online
Filling out the NOTICE OF APPOINTMENT OF AUTHORIZED AGENT OR CONTACT - Nd form is a crucial step for organizations in North Dakota to designate an authorized agent. This guide provides easy-to-follow instructions to help you complete the form accurately online.
Follow the steps to fill out the form correctly.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In Part A, provide the organization identification by entering the name of the organization and the NDPERS Organization ID, ensuring all details are accurate.
- In Part B, specify the appointment or change by filling in the effective date of the appointment or change. Indicate whether you are replacing an agent/contact by entering the previous agent/contact name.
- If you are adding a new authorized agent or contact, provide their name in the designated field under 'Add New Authorized Agent or Contact'.
- In Part C, the new authorized agent or contact must provide their signature and the date of signature to validate the appointment.
- For Part D, check the box indicating the type of authorized agent or contact – remember that only one primary authorized agent is allowed per organization.
- In Part E, check the NDPERS programs that the new authorized agent or contact will represent. Make sure to indicate the effective date for this change.
- Part F requires you to enter the contact information, including the mailing address, city, state, zip code, telephone number, fax number, and a valid email address, or note 'N/A' if not applicable.
- In Part G, certification by executive personnel is needed. This section must be signed and dated by a director or member of the contracting authority, verifying the appointment's approval.
- Once all sections are complete, ensure you save any changes made to the document. You can choose to download, print, or share the form as needed.
Complete your documents online with ease—start filling out the NOTICE OF APPOINTMENT OF AUTHORIZED AGENT OR CONTACT - Nd today!
For inquiries related to ND Medicaid provider enrollment, you can contact the North Dakota Department of Human Services. Their customer service line is available for assistance with the NOTICE OF APPOINTMENT OF AUTHORIZED AGENT OR CONTACT - Nd. Make sure to have your information ready when you call to ensure they can help you efficiently.
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