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Office of Insurance Regulation

Company Admissions

Managed Care

Fiscal Intermediary Service Organizations

NOTICE: Form OIR-C1-905 "Instructions for Furnishing Background Investigative Reports", has been revised. Applications submitted after January 1, 2005 that do not follow the revised instructions may be returned as incomplete.

ALL FORMS

FISCAL INTERMEDIARY SERVICES ORGANIZATION APPLICATION PACKAGE

OIR-C1-1412

FISCAL INTERMEDIARY SERVICES ORGANIZATION REGISTRATION

OIR-C1-905

INSTRUCTIONS FOR FURNISHING BACK GROUND INVESTIGATIVE REPORTS

OIR-C1-903

REQUEST FOR PAYMENT OF FINGERPRINT CHARGES

OIR-C1-938

FINGERPRINT CARD INSTRUCTIONS

OIR-C1-1423

BIOGRAPHICAL AFFIDAVIT