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allow adequate notice, based on the Adverse Action Calendar, that the adverse action will occur.

Once the required documentation is received the Designee will: 1. Add the provider to the provider’s case in ICCIS through the Staff/HH screen; 2. Change the provider (applicant) name through the ICCIS Application screen by selecting the newly entered information; 3. Designees must send via email or fax the State of Alaska Substitute W-9 form to the CCPO Accounting Staff at CCPO@alaska.gov using subject line “ICCIS Provider Legal Name Change.” The CCPO Accounting Staff will within two (2) business days of receiving the State of Alaska Substitute Form W-9: 4. Compare the State of Alaska Substitute Form W-9 to the provider (applicant) name entered in ICCIS to ensure they are the same. If they are not the same, the form is returned to the Designee to update ICCIS. After confirming the name and updating ICCIS, the Designee must resend the State of Alaska Substitute Form W-9; 5. Access the provider’s information in IRIS; o If the name 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 name in IRIS does not match the State of Alaska Substitute Form W-9, the form is emailed to DOF to update IRIS; and 6. Email the Designee the changes have been made to the provider’s name in IRIS. The DOF process usually takesthree (3) to five (5) business days.

The Designee will set an alert in the provider’s case in ICCIS to follow up with the CCPO Accounting Staff if they have not been notified of the name change within ten (10) business days of the request being sent. 3. In-home Provider When the parent (provider) using an In-home caregiver reports their legal name has changed the Designee will enter a case note in the family’s case in ICCIS documenting the change received and forward a copy of the parent’s government issued photo identification supporting the change to the

The Designee will send an email directly to DPA Systems Support the name change in the family’s case in ICCIS at