OIG Compliance NOW - Hebrew Home Vendors

NOTICE OF VENDOR REQUIREMENT TO PROVIDE TAXPAYER IDENTIFICATION NUMBER (TIN)

As a current Vendor/Contractor for Hebrew Home, you have been notified of your requirement to participate in the Hebrew Home internal vendor management system update project, and to provide correct business name and taxpayer identification number (TIN) information to Hebrew Home.

Please utilize the form template below to provide the required information to Hebrew Home. You will need to enter your correct business name as shown on your state business certificate, your tax identification number (TIN), and the unique identifier code from the letter that you received in the mail. Also, you will need to provide an email address so that you can receive a confirmation after completing the form.

Any questions related to this program may be directed to Ann Marie Levine at (718) 581-1772.

Vendor Business Information

*Vendor Legal Name:

* Vendor TIN:

*Locate your TIN on your State Business Certificate

Vendor Independent Contractor Information

* First Name:

Middle Name:

* Last Name:

* SSN:

Vendor Business Address

Address:

Address2:

City:

State:

Zip Code:

* Phone:

Fax:

Email:

Vendor Remit-to Address

Same as the vendor business

Address:

Address2:

City:

State:

Zip Code:

Vendor Contact Information

* First Name:

* Last Name:

Title:

* Email:

Contact Us

OIG Compliance NOW, LLC
49 Court Street
Binghamton, NY 13901

Phone: (607) 240-2400
Fax: (607) 722-1877
E-mail: info@oigcompliancenow.com

Why OIG Compliance Now?

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OIG COMPLIANCE NOW, LLC is a Limited Liability Corporation and is not affiliated with the United States Federal Government in any way. OIG COMPLIANCE NOW, LLC is not a government agency, nor is it approved, endorsed or authorized by the Department of Health and Human Services, the Office of Inspector General or with any agency of the federal or any state government to conduct its business.

Hebrew Home Vendors