Receiver Information Sample Clauses

Receiver Information. This section identifies the Division of Workers’ Compensation and the two individuals who will be used as contacts for the trading partner: a primary and alternate administrator.
AutoNDA by SimpleDocs
Receiver Information. Complete all of the following fields for each receiver that you want to designate. Add/Remove: If you selected Change Enrollment in Part 1 of the form, select the appropriate check box to indicate whether you want to add or remove the associated receiver. Receiver Name: Complete legal name of institution, corporate entity, practice, or provider designated as the receiver. DBA: If applicable, enter the “Doing Business Asoperating name of the receiver entity. Contact Person: Name of a contact in the receiver office. Address fields: Address (number, street name, city, state, and ZIP Code) for the receiver.

Related to Receiver Information

  • User Information Any user or usage data or information collected via Station’s digital properties or related to Station’s digital properties, or any information collected from websites operated by Station’s affiliates under this Agreement, shall be the property of Station and/or such affiliates. Advertiser shall have no rights in such information by virtue of this Agreement.

  • Vendor Information Vendor understands that as part of Hinsdale Central School District’s obligations under New York Education Law Section 2-d, Vendor is responsible for providing Hinsdale Central School District with Vendor information (see Vendor Information for Data Privacy and Security) to include:

  • Member Information a. ODM, or its designee, will provide membership notices, informational materials, and instructional materials to members and eligible individuals in a manner and format that may be easily understood. At least annually, ODM or its designee will provide current MCP members with an open enrollment notice which describes the managed care program and includes information on the MCP options in the service area and other information regarding the managed care program as specified in 42 CFR 438.10.

  • Contractor Information The Contractor will provide up to date information for each of the following in the form and manner specified by OGS:

  • Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account; for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

  • Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account, for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

  • Application Information Employees’ spouses, registered same-sex domestic partners and eligible dependents who choose to participate in the Student Fee Authorization Program must follow the University’s application and enrollment procedures.

  • Subscriber Information Please print your individual or entity name and address. Joint subscribers should provide their respective names. Your name and address will be recorded exactly as printed below.

  • Program Information The Heritage Greece Program is generally described in the literature provided to the Student and available online at: xxxx://xxx.xxx.xxx. It is understood and agreed that the information contained therein is descriptive only and may be changed in the discretion of ACG which reserves the right to make Program changes at any time and for any reason, with or without notice. ACG and/or the Sponsor shall not be liable to the Student because of any such change. ACG reserves all rights, in its sole discre tion, to cancel the Program or any aspect thereof prior to or after departure, and in the case of cancellation after departure, to require the Student to return to the United States, if ACG determines or believes it is in the best interests of the Student.

  • Collection and Use of Your Information You acknowledge that when you download, install, or use the Application, Company may use automatic means (including, for example, cookies and web beacons) to collect information about your Mobile Device and about your use of the Application. You also may be required to provide certain information about yourself as a condition to downloading, installing, or using the Application or certain of its features or functionality, and the Application may provide you with opportunities to share information about yourself with others. All information we collect through or in connection with this Application is subject to our Privacy Policy. By downloading, installing, using, and providing information to or through this Application, you consent to all actions taken by us with respect to your information in compliance with the Privacy Policy.

Time is Money Join Law Insider Premium to draft better contracts faster.