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How to fill out the Sfn1168 online
This guide provides a comprehensive overview of how to fill out the Sfn1168 online. By following these steps, you will be able to complete each section of the form accurately and efficiently, ensuring compliance with the necessary regulations.
Follow the steps to complete the Sfn1168 form online.
- Press the ‘Get Form’ button to access the Sfn1168 document and open it for editing.
- In the managing employee/control interest section, provide the required information for current agents and managing employees including their names, titles, DOB, SSN, and work telephone numbers. Ensure to include the person signing the form.
- Complete the conviction information section, indicating whether there are any convictions related to individuals with ownership or control interests, and provide additional details if necessary.
- Finally, reach the signature section where the authorized representative must print their name, provide their title, date of birth, social security number, and sign the form to validate the information provided.
Complete your Sfn1168 form online today to ensure your application is processed without delay.
Related links form
Application Information All providers are required to apply for enrollment electronically on the ND Health Enterprise MMIS portal. The exception is Qualified Service Providers. All enrollment documentation submitted must include the application tracking number (ATN) from the online enrollment application.
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