All materials are reviewed on a first in basis. Expediated reviews will be considered upon request.

PLEASE NOTE: IFG allocates 5-business days to review intake submissions. Turnaround time for complete marketing review and approval is ≤ 60 days.

Please Provide Your Agency Name, NPN or EIN

Agency Name *

Agency NPN *

Agency EIN *

Contact Info of Submitter

First Name *

Last Name *

Phone *

Email *

Agent NPN Number *

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 *

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

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

Please Provide ALL Websites, URL's, Landing Pages, or Form Fills Used to Collect Prospect Information. If No Sites or Forms Used Place N/A *

Note: Please separate multiple URLs with a comma.

Audience: Please Select the Intended Material Audience *

Current Members Only

Prospective Members Only

Current & Prospective Members

Material Life Cycle: Select the Material Life Cycle *

Are Carrier Logos Present in Your Submission? *

Yes

No

Material Detail Information: Material ID *

Material Description *

Does The Material Contain Both Part C and Part D Information? *

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.