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Employer Services Agreement and Profile Form

Employer Services Web Application Registration

Published: July 15, 2014

Employers and third party processors must complete this form to register to use the two following electronic reporting tools of the Employer Services Web Application: Lump Sum Reporting and Electronic Termination (eTerm)

Employers should contact the Employer Services Team at employerserviceswebapp@acf.hhs.gov for a brief demonstration of the application prior completing the form.

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