Electronic Participation Information

Contents -

Electronic Participation Information

Complete the following information about the applicant's electronic information.

Web Site Address

Enter the URL for the provider's web site.

Electronic Participation*

Select either Yes or No for the selection by using the radio button next to the field (

). If this answer is Yes, the following two fields are required if provider elects to participate electronically.

Participation Request Date

Enter the date on which electronic participation is requested.

E-mail Address

Enter the complete e-mail address for the provider.

Once the information has been entered and reviewed, click on the Next button at the bottom of the page. As a result, the next section of the application is presented.