Expiration Date: XX/XXXX
APPENDIX B
Registration Data Elements
User ID (Self assigned during the CMS Enterprise Portal registration)
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First Name |
Last Name
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E-mail Address
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Phone Number
|
State
|
Zip Code
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User Type – Agent/Broker (role and NPN), Navigators (employer or grantee organization), Certified application counselor (organization)
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Tricia Beckmann |
File Modified | 0000-00-00 |
File Created | 2023-09-06 |