Expiration Date: XX/XXXX
APPENDIX B
Registration Data Elements
User ID (Self assigned during the CMS Enterprise Portal registration)
|
First Name |
Last Name
|
E-mail Address
|
Phone Number
|
State
|
Zip Code
|
User Type – Agent/Broker (role and NPN), Navigators (employer or grantee organization), Certified application counselor (organization)
|
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Tricia Beckmann |
| File Modified | 0000-00-00 |
| File Created | 2021-01-20 |