Form 1 e-NMSN: Plan Administrator Profile

Department of Health and Human Services

OMB Control No: 0970-0370
Expiration Date: xx-xx-xxxx

Administration for Children and Families
Office of Child Support Enforcement
Agreement to Exchange Electronic
National Medical Support Notices
By completing and providing the information included in the Electronic National Medical Support Notice (e-NMSN) Plan Administrator
Profile Form, the organization agrees that:
The plan administrator, union, or third-party responder shall have appropriate procedures in place to promptly report
confirmed and suspected information security or privacy incidents, including, but not limited to, unauthorized use or
disclosure of Personally Identifiable Information (PII) involving confidential child support information submitted through
OCSE to your organization. As soon as reasonably practicable after discovery, but in no case later than one hour after
discovery of the incident, plan administrator, union, or third-party responder shall report confirmed or suspected incidents
to OCSE as specified in this paragraph. The requirement for the plan administrator, union, or third-party responder to report
confirmed or suspected incidents involving PII to OCSE is based on federal guidance/requirements from the Office of
Management and Budget (OMB), Health and Human Services (HHS), the Federal Information Security Modernization Act of
2014 (FISMA), and the United States Computer Emergency Readiness Team (US-CERT).
Incidents must be reported via email to OCSE using the security mailbox address:
[email protected]
The organization will electronically process and respond to NMSN notices received from an employer or third-party
provider in the same manner as mailed notices, within the required timeframes. Response timeframes and other
instructions are available at: https://www.acf.hhs.gov/css/form/national-medical-support-notice-formsinstructions.
The organization will not impersonate any individual, entity, or association; use false headers; or otherwise conceal
or provide misleading information about their identity while responding to NMSNs electronically.
The organization’s representative completing this form is authorized to act on behalf of the plan administrator,
union, or third-party responder and agrees to provide true, correct, current, and complete information about
the entity identified in the profile form.
The organization will consider the electronic version of the NMSN admissible as evidence in the
same way as paper documents.
The organization will provide written notice to the federal Office of Child Support Enforcement at least 30 days
before it intends to stop sending e-NMSN responses.
A third-party provider certifies that it has authorization to participate in e-NMSN on behalf of their clients and
will provide company names, FEINs, and related information to OCSE for the purpose of processing e-NMSNs.

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e--NMSN Plan Administrator Profile
Instructions
To complete this form and to respond to NMSNs using PDF forms, you must use Adobe Acrobat Reader Version 10
or later. To download this free software, go to https://www.adobe.com/acrobat/pdf-reader.html.
You must complete the required fields followed by a red asterisk *. If there are errors, a popup box will appear
with information about correcting the error.
Plan Administrators and Unions:
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Register as either a plan administrator or union using this form..
Complete the e-NMSN FEINs Spreadsheet to identify each employer and, if applicable, their subsidiaries
for whom you will process and return Part-B responses.
Receive Part-B forms from the employer.
Provide Part-B responses on the pick-up server.

Third-party Responders (only responding to e-NSMNs on behalf of clients):
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Register as Third Party: Responder Only using this form.
Use the e-NMSN FEINs Spreadsheet to identify each employer FEINs for whom you will provide e-NMSN
responses.
Receive e-NMSNs from employers.
Provide Part-A responses on the pick-up server.
Provide Part-B responses, when applicable, on the pick-up server.
If the NMSN is for an employee whose health insurance is through a union or labor organization, forward
Part- B to the union or labor organization.
If you are receiving e-NMSN orders and using a union or labor organization to send responses back to
states, it is your responsibility to forward the orders and encourage the third-party responder to register
with the e-NMSN system.

Note: Third-party responders, plan administrators, or unions that want to receive e-NMSNs for their own
employees must register as an employer.

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General Information
Date: *

(The date you are completing the form using MM/DD/YYYY format.)

FEIN: *

(Primary Federal Employer Identification Number – enter as nine numeric characters with
no hyphen after the second number. This is the FEIN used for the files being transferred.)
Select Third Party: Responder Only if you are responding to Part-A and,
when applicable, Part-B.

Organization Type*

Select Union if you are a union acting as a plan administrator and are
responding to Part-B.)
Organization Name*:

Organization Known as Name (Doing Business As):

Address Information
Enter the employer or third-party provider’s address where child support agencies should mail paper NMSNs.
Address Line 1: *

Address Line 2:
City: *

ZIP Code: *

State: *

ZIP Code Extension:
(Enter a five-digit ZIP code and the optional four-digit extension.)

Contact Information
Enter the organization’s business, technical support and alternate contact information.
Note: At least one person must be designated to received automated emails.

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Business Contact Information
Enter business contact information for working with OCSE to set up e-NMSN and assist with issue resolution.
First Name: *

MI:

Last Name: *

Email: *

Phone Number: *

Fax Number:

Enter numeric characters only.
Include the area code.
Format: 1231231111)

Phone Ext:

Enter numeric characters only.
Include the area code.
Format: 1231231111)

Technical Contact Information
Enter network or system administrator who can provide corporate Internet Protocol (IP) addressinformation and batch
system information.
First Name: *

MI:

Last Name: *

Email: *

Phone Number: *

Fax Number:

Enter numeric characters only.
Include the area code.
Format: 1231231111)
Enter numeric characters only.
Include the area code.
Format: 1231231111)

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Phone Ext:

Alternate Business Contact Information
Enter additional business contact information for working with OCSE to set up e-NMSN and assist with issue
resolution. None of the fields are required.
First Name:

MI:

Last Name:

Email:

Phone Number:

Fax Number:

Enter numeric characters only.
Include the area code.
Format: 1231231111)

Phone Ext:

Enter numeric characters only.
Include the area code.
Format: 1231231111)

Alternate Technical Contact Information
Enter additional technical contact information network or system administrator who can provide corporate
Internet Protocol (IP) address information and batch system information. None of the fields are required.
First Name:

MI:

Last Name:

Email:

Phone Number:

Fax Number:

Enter numeric characters only.
Include the area code.
Format: 1231231111)
Enter numeric characters only.
Include the area code.
Format: 1231231111)

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Phone Ext:

File Processing Information
Review the default selections below and make updates as needed, based on the best option for your organization.

General File Information
Enter information about the file exchange.
Select Yes if you want OCSE to encrypt all files delivered to
your server. OCSE uses GPG for encryption.

Encrypt files: *

Are your files stored behind your organization firewall?
Yes

If you select Yes, you must provide your company’s PGP or
GPG encryption key in a separate email when sending this
profile.
This field is required only if you selected No for the Encrypt files
option.

No

File Processing Information
How do you want to receive and respond to e-NMSNs? Note: If you are registering as a Third-Party Responder you will
only respond to e-NMSNs.
No Programming and Programming Option information is listed
below.

No Programming File Information
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You will receive the NMSN and Part B in PDF format from the employer. If you are a third-party responder, you may
also receive Part A in PDF format from the employer.
You will receive a daily “Processing Summary” of the files that have been picked up from your server, dropped off to
your server, or files returned to correct errors.
The OCSE standard naming conventions (in the chart below) must be used for the file names.
Note: Adobe Reader is the only PDF software compatible with e-NMSN.
You can skip to page 8 for Server Information.

Programming (System-to-System) File Information
Information for the following section is required if the Programming option is selected above.
Select e-NMSN / Part-A file format:
If you chose Third Party: Responder Only as your organization type,
select a Part-A Response File format. If you are a plan administrator or a
union, skip this question.
Flat files have a .txt file extension.
Select Part-B Response file format:*
Flat files have a .txt file extension.
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Do you want a copy of the NMSN in PDF file format?
Yes

No

When you select a programming option above, you can also choose to
receive individual NMSN PDFs.

Error File
The file submitter will receive an error file for the following conditions:
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If there are problems with file header, file trailer, or other file-level structures, the entire file will be returned.
If errors are in the batch header or batch trailer, the entire batch will be returned with all response records.
If there are response record errors, the records with errors are returned in the file with their batch header
and trailers. There can be multiple batches returned in the file.
You will receive a daily “Processing Summary” of the files that have been picked up from your server, dropped
off to your server, or files returned to correct errors.

File Naming Convention
Files can be named using OCSE’s standard file naming convention or the organization’s file naming convention. The
naming convention for PDF files is standard for this process.
1.
2.

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In the Standard/Organization-Supplied File Naming Convention column, select whether you want to use
your organization’s file naming convention or OCSE’s standard file naming convention.
In the File Naming Convention column, take the following steps:
If you are using your organization’s file naming convention, enter the file naming convention. For
example, for the file with notices (Incoming State Notice Files), you can enter enmsn.mybiz.notices.txt.
This is the name of the file you will receive that includes your notices.
If you are using OCSE’s standard file naming convention, an example file name is in the table below. For
more information about file naming conventions and formats, refer to the e-NMSN Software Interface
Specifications.

File Type

Standard/Organization-SuppliedFile File Naming Convention
Naming Convention

Outgoing Part-A Files
If you are returning the Part-A
responses, this field is required.

OCSE Standard

(Example: 123456789.
ARF.200708060115087.0000.txt)

Organization-Supplied
Outgoing Part-B Files *
OCSE Standard

(Example: 123456789.
BRF.200708060115087.0000.txt)

Organization-Supplied

Server Information (Required for Both Options)
This information is required for the No Programming and Programming (System-to-System) file information.

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Separate directory/folder names for file pick-up and file drop-off (must be different from those used for e-IWO).
This information is required for the production environment and optional for the test environment.
Server ID (may be the same as those used for e-IWO)
Server passwords
IP address
Host name is optional

The only methods offered for transferring e-NMSN data is for our servers to initiate the sending and retrieving of files
using SFTP or FTPS. We can only use FTPS with a partner's server that has our Certificate Authority (CA) installed, which
dedicates that server to exchanging files with our server using only FTPS.
File transfer preference: *
SFTP
FTPS

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Pick Up Server Information
Enter your organization’s server information for the e-NMSN server to retrieve files.

Production Server User ID:

Test Server User ID:

Production Server Password:

Test Server Password:

Production Server IP Address:

Test Server IP Address:

Production Server Host Name:

Test Server Host Name:

Production Server Port:

Test Server Port:

Production Server Directory Name: *

Test Server Directory Name:

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this voluntary information
collection is for OCSE to implement the electronic NMSN process and capture preferences for Plan Administrators. Public reporting
estimated burden for this collection of information is 0.22 hours per respondent, including the time for reviewing instructions, gathering
and maintaining the data needed, and reviewing the collection of information. As provided by 42 U.S.C. § 653(m)(2), any confidential
information collected for this program is accessed only by authorized users. A federal agency may not conduct or sponsor an information
collection without a valid OMB Control Number. No individual or entity is required to respond to, nor shall an individual or entity be subject
to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act of 1995,
without a current valid OMB Control Number. If you have any comments on this collection of information, please contact
[email protected].

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