Agent Registration Renewal Update

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Agent Registration (Renewal Update) Form and Instruction

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Label

PDF Name

Item Type

OMB Number: 09060081 Expiration Date:
mm/dd/yyyy

Agent
Registration
(Renewal
Update)

Modal

When the user selects the link the modal
is displayed with the public burden
statement content.

Edit

Agent
Registration
(Renewal
Update)

Link

On the Review Your Information page
under Organization Information, when the
user selects the “Edit” link, the form for
Organization Information page is displayed
and prefilled. Form fields are Department,
Country, Street Address, Street Address
Line 2, City, State, ZIP, Phone Number, EIN
(Employer Identification Number) and
Company or Organization Website
Address. The user can change the
information.

Edit

Agent
Registration
(Renewal
Update)

Link

On the Review Your Information page
under Certifying Official, when the user
selects the “Edit” link, the form for
Certifying Official page is displayed and
prefilled. Form fields are First Name, MI,
Last Name, Title, Phone, Extension, Email
Address and Employee ID. The user can
change the information for Title, Phone,
Extension, Email Address and Employee
ID.

Trigger

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PDF Name

Item Type

I need to change the
certifying official
information

Agent
Registration
(Renewal
Update)

Check Box On the Certifying Official page, selecting
the checkbox displays radio button
selections.
• Enter a new certifying official
• Make myself the certifying official
• Make administrator (name and
User ID of another administrator
user account) the certifying official

Trigger

If the user is currently the certifying
official, then Make myself the certifying
official is preselected.
If the user is the only administrator for the
organization’s account, then “Make admin
Make administrator (name and User ID of
another administrator user account) the
certifying official” is not displayed.
Otherwise, a radio button is displayed for
all administrator accounts for the
organization, except the user’s account.
First Name

Agent
Registration
(Renewal
Update)

Text Entry Selecting the radio button “Enter a new
certifying official” displays the form with
First Name, MI, Last Name, Title, Phone,
Extension, Email Address and Employee
ID.

MI

Agent
Registration
(Renewal
Update)

Text Entry Selecting the radio button “Enter a new
certifying official” displays the form with
First Name, MI, Last Name, Title, Phone,
Extension, Email Address and Employee
ID.

Last Name

Agent
Registration
(Renewal
Update)

Text Entry Selecting the radio button “Enter a new
certifying official” displays the form with
First Name, MI, Last Name, Title, Phone,
Extension, Email Address and Employee
ID.

Label

PDF Name

Item Type

Title

Agent
Registration
(Renewal
Update)

Text Entry Selecting the radio button “Enter a new
certifying official” displays the form with
First Name, MI, Last Name, Title, Phone,
Extension, Email Address and Employee
ID.

Phone

Agent
Registration
(Renewal
Update)

Text Entry Selecting the radio button “Enter a new
certifying official” displays the form with
First Name, MI, Last Name, Title, Phone,
Extension, Email Address and Employee
ID.

Extension

Agent
Registration
(Renewal
Update)

Text Entry Selecting the radio button “Enter a new
certifying official” displays the form with
First Name, MI, Last Name, Title, Phone,
Extension, Email Address and Employee
ID.

Email Address

Agent
Registration
(Renewal
Update)

Text Entry Selecting the radio button “Enter a new
certifying official” displays the form with
First Name, MI, Last Name, Title, Phone,
Extension, Email Address and Employee
ID.

Employer ID

Agent
Registration
(Renewal
Update)

Text Entry Selecting the radio button “Enter a new
certifying official” displays the form with
First Name, MI, Last Name, Title, Phone,
Extension, Email Address and Employee
ID.

Make myself the
certifying official

Agent
Registration
(Renewal
Update)

Radio
Button

Selecting the radio button “Make myself
the certifying official” hides the form with
First Name, MI, Last Name, Title, Phone,
Extension, Email Address and Employee
ID.

Make administrator
(name and User ID of
another administrator
user account) the
certifying official

Agent
Registration
(Renewal
Update)

Radio
Button

Selecting the radio button “Make
administrator (name and User ID of
another administrator user account) the
certifying official” hides the form with First
Name, MI, Last Name, Title, Phone,
Extension, Email Address and Employee
ID.

Trigger

Label

PDF Name

Item Type

Edit

Agent
Registration
(Renewal
Update)

Link

The User Accounts section on the Review
Your Information page is only displayed
for Renewal. When the user selects the
Edit link, the page to Update User
Accounts is displayed with list user
accounts for the organization. The user
can select accounts to delete if applicable.
On selection of Exit or Continue, the user
is returned to the Review Your
Information page with any accounts
selected for deletion noted on the table.

Is this list complete
and correct?

Agent
Registration
(Renewal
Update)

Radio
buttons

The Entity Relationships section and radio
buttons “Yes” and “No/Not Sure” on the
Review Your Information page are only
displayed for Renewal.

Trigger