R590-244-13. Miscellaneous License Amendments and Changes to an Agency's Employer Identification Number (EIN)

  (1) All miscellaneous license amendments shall be submitted electronically.

  (2) The following five miscellaneous license amendments shall be submitted via SIRCON or NIPR:

  (a) a change of residence, business, or mailing address within the same state;

  (b) a change of email address;

  (c) a change of telephone number;

  (d) a change of an individual licensee's name; or

  (e) a change of the licensed individual designated as the person responsible for the regulatory compliance of the agency.

  (3) The following five miscellaneous license amendments shall be submitted electronically via facsimile or as a PDF attachment to an email, except that a license amendment identified in (d), (e) and (f) shall be submitted via SIRCON or NIPR once the amendment becomes available electronically from SIRCON or NIPR:

  (a) a voluntary surrender of a license or line or authority;

  (b) a clearance letter request;

  (c) a change of an agency name;

  (d) a change of residence, business, or mailing address from one state to another state; or

  (e) a change of position or title of an owner, partner, officer, or director of an agency.

  (4) A miscellaneous license amendment submitted in accordance with this section shall contain:

  (a) the name and title of the individual submitting the amendment;

  (b) the relationship to the licensee of the individual submitting the amendment; and

  (c) the following attestation made by the individual submitting the amendment: "I hereby attest that all of the information submitted is true and correct, and that I am the individual licensee for whom the requested change is being submitted, or an authorized responsible representative of the individual or agency licensee for whom the requested change is being submitted."

  (5) A change of Employer Identification Number (EIN):

  (a) cannot be processed as a miscellaneous license amendment; and

  (b) the entity must apply as a new license applicant.