Hidden Form Field (Do Not Delete)

To start your submission, add your Agency's name below...

Agency NPN *

Use "NA" if not applicable

Agency EIN *

Use "NA" if not applicable

Agent NPN Number *

Use "NA" if not applicable

Are you working with a Vendor? *

If YES, Please Include Following Information Below...

Marketing Vendor Name *

Vendor Point of Contact *

Marketing Vendor Email *

Marketing Vendor Phone Number *

Marketing Vendor Address *

Type of Material: *

Marketing

Communication

Contract/Submission Type: This material includes or addresses any of the following content. *

Geography For Use: Is this campaign for a national audience? *

Please select the states where this marketing will be seen: *

Please provide all links to ANY Landing Pages, Sales Funnels related to your Paid advertising campaign below. *

Note: Please separate multiple URLs with a comma.

Line of Business *

Audience: Please Select the Intended Material Audience *

Current Members Only

Prospective Members Only

Current & Prospective Members

Material Life Cycle: Select the Material Life Cycle

Please select the Carriers your agency are contracted with below: *

Are Carrier Logos Present in Your Submission? *

Yes

Carrier Logos: Select All That Apply *

Is Co-Branding present in your submission? *

Yes

Add Material ID/SMID *

Please include M or C to indicate Marketing or Communication Material

Material Description *

Please be specific and explain sales use case strategy and intent!

File Upload: Choose a (Single) File to Upload...

Attestation: Please Acknowledge Before Submitting: *

Based on my knowledge, information, and belief, I attest that the material is complete, accurate, and truthful. This attestation applies to all requirements under the File and Use Certification process and other CMS guidance.