Authorization holders must notify the Office of information
changes within 30 calendar days of the change. Notice must be submitted in
writing, at the Office, by regular U.S. Postal Service, facsimile transmission,
or electronic mail. Changes include:
(1) The authorization holder's first and last
name. The change must be accompanied by:
(a)
A government-issued marriage certificate or license (signed by a government
official and including a filed date, stamp, seal or other notation showing that
the document has been filed with a government agency);
(b) A certificate of registered domestic
partnership issued by a city, county or state vital statistics
agency;
(c) A U.S. city, county or
state court-issued divorce decree, judgment of dissolution or annulment of
marriage, or judgment of dissolution or annulment of domestic
partnership;
(d) A
government-issued death certificate of spouse, that includes a connection to
your current full legal name (signed by a government official and including a
stamp to show that the document has been filed);
(e) A U.S. city, county or state court-issued
adoption decree;
(f) A U.S. city,
county or state court-issued legal name change decree;
(g) A U.S. city, county or state court-issued
custody decree or guardianship decree; or USCIS Certificate of Naturalization
showing new name; and
(h) You must
also provide one acceptable form of photographic identification in addition to
the required legal name change documentation pursuant to OAR
331-030-0000(8)
and (10).
(2) The
authorization holder's residential or mailing address, telephone number
including area code, employment status, or work location.
(3) A facility license holder's facility name
or Assumed Business Name as filed with Secretary of State, Corporations
Division, business telephone number, including area code, address changes
resulting only from city or U.S. Postal Service action, mailing address; or
closure or sale of business facility or practice.
(4) An independent contractor authorization
holder's facility name, physical address, telephone number including area code,
and license number; changing permanent work location or performing services at
multiple licensed facilities on a permanent or temporary basis.
Notes
Or. Admin. R.
331-010-0040
HLO 1-2004, f. & cert.
ef. 2-13-04; HLA 1-2009, f. & cert. ef. 6-1-09;
HLO
71-2018, amend filed 04/30/2018, effective
5/1/2018;
HLO
83-2018, minor correction filed 12/17/2018, effective
12/17/2018
Statutory/Other Authority: ORS
676.565,
ORS
676.615 & ORS
681.700-676.730
Statutes/Other Implemented: ORS
676.565,
ORS
676.615 & ORS
681.700-676.730
