Form 1 e-NMSN: State Profile

OMB Control No: 0970-0370 Expiration Date: xx/xx/xxxx

Department of Health and Human Services Administration for Children and Families Office of Child Support Services

Agreement to Exchange Electronic National Medical Support Notices

By completing and providing the information on this form, the state agrees it will:

Transmit NMSNs electronically to employers, plan administrators, third-party processors, and agents that participate in the OCSS e-NMSN process.

Treat e-NMSNs in the same manner as mailing paper notices to the employer.

Consider the electronic version of the NMSN admissible as evidence in the same way as paper documents.

Not impersonate any individual, entity, or association; use false headers; or otherwise conceal or provide misleading information when sending NMSNs electronically.

Provide true, correct, current, and complete information about the state identified in the profile form.

Provide written notice to the federal Office of Child Support Services at least 30 days before you intend to stop sending e-NMSNs.

Agree to accept paper versions of the Part-B response from plan administrators, unions, or labor organizations not participating in the OCSS e-NMSN process.

Acknowledge it is the state’s responsibility to contact an employer directly if a Part-A and, when appropriate, Part-B response is not received after sending an e-NMSN.

e-NMSN State Profile Form

Instructions

To complete this form, you must use Adobe Acrobat Reader version 10 or later. To download this free software, go to https://acrobat.adobe.com/us/en/acrobat/pdf-reader.html.

You must complete the required fields followed by a red asterisk * and email it to the e-NMSN team (eNMSNmail@acf.hhs.gov). If there are errors, a popup box will appear with information about correcting the error.

General Information

Date:

(The date you are completing the form using MM/DD/YYYY format.)

FIPS/Locator: * State Name: *

(Enter the FIPS/Locator code as five numeric characters, including three trailing zeros. For example, enter 04000, not 04.)

Address Information

Enter the state child support office’s address. Address Line 1: *

Address Line 2:

City: * ^{State: *}

_{ZIP Code: *} ZIP Code Extension

-

(Enter a five-digit ZIP code and the optional four-digit extension.)

Contact Information

Enter the state’s primary business, primary technical, and additional contact information.

Primary Business Contact Information

Enter the business contact information for working with OCSS to set up e-NMSN and assist with issue resolution.

First Name: * ^MI: Last Name: *

Email: *

Send email notifications, including file processing information, to this email address.

Phone Number: *

Fax Number:

(Enter numeric characters only. Include the area code. Format: 1231231111)

(Enter numeric characters only. Include the area code. Format: 1231231111)

Phone Ext:

Primary Technical Contact Information

Enter a network or system administrator who can provide Internet Protocol (IP) address information and batch system information.

First Name: ^MI: Last Name:

Email:

Send email notifications, including file processing information, to this email address.

Phone Number:

Fax Number:

(Enter numeric characters only. Include the area code. Format: 1231231111)

(Enter numeric characters only. Include the area code. Format: 1231231111)

Phone Ext:

Additional Business Contact Information

Enter the contact information that will be shared with employers, third-party providers, plan administrators, and other stakeholders for case-specific questions.

First Name: ^MI: Last Name:

Email:

Send email notifications, including file processing information, to this email address.

Phone Number: ^{Phone Ext:}

(Enter numeric characters only. Include the area code. Format: 1231231111)

Fax Number:

(Enter numeric characters only. Include the area code. Format: 1231231111)

File Processing Information

Use this section of the form to specify whether you will send and receive files in XML or flat file format. You can choose to use the standard e-NMSN file naming convention or your state’s file naming convention.

Make selections below based on the best option for your state.

General File Information

Enter information about the file exchange.

Encrypt files: *

Select Yes if you want OCSS to encrypt all files delivered to your server. OCSS

uses GPG for encryption.

If you select Yes, you must attach in a separate email your state’s PGP or GPG encryption key when returning this profile form.

Are your files stored behind your organization firewall?

This field is required only if you selected No for the Encrypt files option.

Error File

The file submitter will receive an error file for the following conditions:

• If there are problems with the file header, file trailer, or other file-level structures, the entire file will be returned.

• If errors are in the batch header or batch trailer, the entire batch will be returned with all notice records.

• If there are notice record errors, the records with errors are returned in the file with their batch header and trailers.

Multiple batches can be returned in the file.

File Information

Select the file format below. File format: *

Flat files have a .txt file extension.

1. In the Standard/State-Supplied File Naming Convention column, in the table below select whether you want to use your state’s file naming convention or the OCSS standard file naming convention.

2. In the File Naming Convention column:

   • Enter the file naming convention if you are using your state’s file naming convention. For example, for files with notices (Outgoing State Notice Files), you can enter enmsn.mybiz.notices.txt. This is the name of the file you will send that includes your notices.

   • Select OCSS Standard if you are using the OCSS standard file naming convention. An example file name is in the table below. For more information about file naming conventions and formats, refer to the e-NMSN Software Interface Specifications.

3. If states will receive FEIN push files, select the State-Supplied radio button in the Standard/State-Supplied File Naming Convention column and enter the state’s file naming convention in the File Naming Convention column. There is no OCSS standard file naming convention for FEIN push files.

File Type	Standard/State-Supplied File Naming Convention	File Naming Convention
Outgoing State Notice Files *	OCSS Standard	(Example: 180000000. ENR.2020011701157.0000.txt)
	State-Supplied
Incoming Part-A Response Files *	OCSS Standard	(Example: 180000000. PAR.2020011701157.0000.txt)
	State-Supplied
Incoming Part-B Response Files *	OCSS Standard	(Example: 180000000. PBR.2020011701157.0000.txt)
	State-Supplied
FEIN Push Files *	State-Supplied

Server Information

To send and receive e-NMSN files, we need the following server information:

• Separate directory/folder names Server ID

• Server passwords

This information is required for both the production and test environments. An IP address is required; a host name is optional. The following are the only methods available to transmit e-NMSN data to our servers:

• SFTP over a VPN tunnel

• FTPS over a VPN tunnel

We can only use FTPS with a state server that has our Certificate Authority (CA) installed, which dedicates that server to exchanging files using only FTPS with our server.

File transfer preference: *

Pick-Up Server Information

Enter your state’s server information for file pick-up.

Production Server User ID:

Production Server Password:

Production Server IP Address:

Production Server Host Name:

Production Server Port:

Production Server Directory Name: *

Test Server User ID:

Test Server Password:

Test Server IP Address:

Test Server Host Name: Test Server Port:

Test Server Directory Name:

Drop-Off Server Information

Enter your state’s server information for file drop-off.

Production Server User ID: Production Server Password:

Production Server IP Address:

Production Server Host Name:

Production Server Port:

Production Server Directory Name: *

Test Server User ID:

Test Server Password:

Test Server IP Address:

Test Server Host Name:

Test Server Port:

Test Server Directory Name:

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this voluntary information collection is for OCSS to implement the electronic NMSN process and capture preferences for states. Public reporting estimated burden for this collection of information is 0.22 hours per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. As provided by 42 U.S.C. § 653(m)(2), any confidential information collected for this program is accessed only by authorized users. A federal agency may not conduct or sponsor an information collection without a valid OMB Control Number. No individual or entity is required to respond to, nor shall an individual or entity be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, without a current valid OMB Control Number. If you have any comments on this collection of information, please contact OCSSFedSystems@acf.hhs.gov.

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