| Change of
Address Requests Due to Hurricane Katrina
The National Supplier Clearinghouse
(NSC) is committed to assisting suppliers who have been directly
impacted by Hurricane Katrina. If you are a supplier in one of the
affected areas who has relocated due to this disaster, you can fax
your Change of Address request to the NSC for quicker processing.
To send a change of information
to the NSC, you need to fill out a
CMS-855S application form as follows:
Section 1: Check the
"Change of Information..." box, write your supplier number in
the space provided, and check the numbered boxes that indicate
the sections being changed;
Section 2: Fill out
section 2.A. 1;
Section 4: Complete
section 4 in its entirety;
Section 15: Have the
appropriate individual who is listed as an approved signer (Authorized
or Delegated Official) sign section 15; and
Check the appropriate change,
add, delete box at the top of each section and enter an "Effective
Date".
This information can also be
found on our Web site. From the home page, select ‘Other
Partners’, ‘National Supplier Clearinghouse’, ‘Forms’, and ‘Change
of Information Guide’.
You may fax your change of
address request to the NSC at (803) 935-1203. Please write in bold
letters on the top of the form, “Hurricane Katrina.” You must
follow up with an original form via mail as soon as possible.
Please note: Only checks and
remittance notices are sent to the “Pay To” address. All other
correspondence will be sent to the “Mail To” address.
If you are following up your
faxed change of address form via overnight delivery, please send
the information to the following address:
National Supplier
Clearinghouse, AG-495
Palmetto GBA
Building One
2300 Springdale Drive
Camden, SC 29020 |
