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4300-1 E. MAILING ADDRESS When a provider is changing their mailing address, a State of Alaska Substitute Form W-9 is required for all provider types except for In- home providers. 1. Licensed Provider a. Licensing Specialist will: • Make necessary changes in the demographic tab in the facility module of ICCIS. • Notify partner agencies of the changedaddress.

If the provider submits the State of Alaska Substitute Form W-9 to their Licensing Specialist, an MOA Licensing Specialist must fax; CCPO Staff will scan and email the State of Alaska Substitute Form W-9 to the CCPO Accounting Staff at: ccpo@alaska.gov; using subject line “ICCIS Facility Mailing Address Change.”

b. Designee will: Upon notification from the Licensing Specialist, if the provider is participating in the CCAP, the Designee will contact the provider requesting the State of Alaska Substitute Form W-9 and upon receipt forward to the CCPO Accounting Staff. c. The CCPO Accounting Staff will within two (2) business daysof receiving the State of Alaska Substitute Form W-9: • Compare the State of Alaska Substitute Form W-9 to the mailing address in ICCIS to ensure they are the same. If they are not the same, the form is returned to the Licensing Specialist to update ICCIS. After confirming the addressand updating ICCIS, the Licensing Specialist must resend the State of Alaska Substitute Form W-9; o Access the provider’s information in the Integrated Resource Information System (IRIS); o If the address in IRIS matches the State of Alaska Substitute Form W-9 it is filed in the provider’s billing file and no further action is needed; or o If the address in IRIS does not match the State of Alaska Substitute Form W-9, the form is emailed to Division of Finance (DOF) to update IRIS; and o Email the Licensing Specialist the changes have been made to the provider’s mailing address in IRIS. The DOF process usually takes three (3) to five (5) business days. 2. Approved Relative Provider a. The Designee will: