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Responsible Reporting Entity Information

This page requires you to enter information about the RRE’s company or organization. You will later be asked to provide information specific to your Authorized Representative.

Required fields are noted by an asterisk.

Company EIN/TIN:	The IRS-assigned employer identification number (EIN) or tax identification number (TIN) associated with the organization reflected under this Section 111 registration. If you have more than one TIN, you may submit this registration with any one of those TINs. If you will be requesting multiple RRE IDs, you may use the same TIN for each or different TINs. If the RRE you are registering is a foreign entity that does not have an IRS-assigned EIN/TIN then you may use a fake or pseudo-TIN in the format of 9999xxxxx where 'xxxxx' is a 5-digit number created by the RRE.
Company Name:	The company name associated with this Section 111 registration.
Company Address:	The corporate address associated with the company. The second line of the street address and Zip+4 are optional. If the RRE does not have a mailing address in the United States, enter 'Foreign Country' in the state field and leave the other address fields blank.
NAIC Number:	The 5-digit company code assigned to your company by the National Association of Insurance Commissioners (NAIC). If you are not registered with the NAIC, then you do not need to complete this field. If you have more than one NAIC Company Code, you may submit this registration with any one of those NAIC Company Codes.
Company Telephone:	Telephone number of your corporate office. Telephone number is not required for foreign RREs, but can be provided if a U.S. number is available.
Company Fax :	Facsimile number of your corporate office.
Reporter Type:	Type of Section 111 RRE. Select Group Health Plan (GHP) or Liability / No-Fault / Workers' Compensation by clicking the appropriate radio button.

After you have correctly entered all Responsible Reporting Entity information, click the Continue button to proceed to the next page in the New Registration step.

Click on the Cancel button to return to the previous page.