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The ICD-072 form represents a crucial instrument for insurers seeking to establish electronic reporting capabilities for Maryland Insurance Certifications, specifically Form FR-19. This document requires the requester to provide key identification details, including the company name and contact information, while identifying the insurance firms for which the user is authorized to issue certifications. It serves as a portal to remote access, allowing insurance agents to electronically report certifications to the Maryland Insurance Compliance Division, thereby streamlining the process involved in meeting state compliance standards. The form mandates not only the completion of personal information but also necessitates approval from an insurance company representative, ensuring accountability and oversight in the usage of this access. With sections dedicated to acknowledging the importance of network security and the responsibilities associated with remote access, the ICD-072 stresses adherence to best practices in cybersecurity. Notably, it specifies the need for virus protection software on user devices and outlines the potential ramifications for violations of the terms of use, highlighting the significant role that digital security plays in today’s insurance landscape.
Icd 072 Example
Motor Vehicle Administration
6601 Ritchie Highway, N.E.
Glen Burnie, Maryland 21062
MD MVA
REQUESTER INSTRUCTIONS:DATE of REQUEST :
Complete top section of form, listing each “Insurer” company you are authorized to issue Maryland Insurance Certifications (Form |
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“SignDate” sign, and date. This request may require approval from your Insurance Company or Agency Officer. Mail to ICD Business |
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Administrator at MVA Room 140, 6601 Ritchie Hwy, Glen Burnie, MD 21062, for authorization signature. ICD Business Administrator |
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will submit signed form to MVA Security Officer for verification of access type(s). |
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ACTION: ❑ New Request ❑ Account Change |
❑ Account Deletion |
❑ Add Insurer Association ❑ Remove Insurer Association |
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USERID: ____________________________ |
Producer License No issued by MD Ins Admin ______________________________ |
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(assigned by MVA) |
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MD Insurance Agent: ___________________________________________________________ |
Phone: ( ) ____________________ |
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Last |
First |
MI |
Suffix |
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Ins Co / Agency Name: ______________________________________ Address:______________________________________________
_______________________________________________________________________________________________________________
Agency Phone Number: ( )______________________________ Agency Fax Number: ( )______________________________
EMail Address:______________________________________________________________________________ |
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Insurer’s Agent is Authorized to Issue Maryland Insurance Certifications (form |
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Insurer NAIC Code is the 5 Digit Number assigned by the National Association of Insurance Commissioners |
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Insurer NAIC |
Insurer Name |
Insurer NAIC |
Insurer Name |
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Purpose of Remote Access: To report Maryland Insurance Certifications Forms
ACKNOWLEDGMENT: Remote Access to the MDOT/MVA network is a privilege. I hereby acknowledge that remote access is authorized for my use only and that all passwords and user names are to be kept confidential at all times. By requesting a remote access account, I acknowledge that I will install or already have installed virus protection software on my remote (this includes business, home or laptop) system. In addition, I authorize MVA and/or their contractor to test the security of my connection to the MVA network by performing a coordinated vulnerability assessment when needed of my connection to the MVA network. Installation of the virus protection and applying virus signature updates is my responsibility. I understand that failure to do so may result in loss of remote access privileges. MVA employees are not responsible for any operating system, hardware or software application problems encountered by any MVA Remote Access User when using the designated applications to connect to the MVA
network. I have signed the MDOT Security Advisory agreement and I am aware of terms and conditions of the agreement.
Requester Signature/Date: _____________________________________________________________________________
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INSURANCE CO/AGENCY OFFICER: I authorize the requestor to be granted access to the MD ACIS
ON BEHALF OF INSURANCE COMPANY AGENCY _______________________________________________________________
INSURANCE CO/AGENCY OFFICER Name & Title (Please Print): ______________________________________________________
INSURANCE CO/AGENCY OFFICER Signature/Date: ________________________________________________________________
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MD MVA ACIS BUSINESS ADMINISTRATOR: I authorize the requestor to be granted access to the ACIS
MVA ACIS Business Administrator Name (Please Print):_________________________________________________________________
MVA ACIS Business Administrator Signature/Date: ____________________________________________________________________
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IMPLEMENTATION DETAILS (TO BE COMPLETED BY MVA ONLY)
MVA Security Officer Signature/Date: __________________________________________________________________
For more information, please call:
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MARYLAND DEPARTMENT OF TRANSPORTATION
OTTS OFFICE OF DATA SECURITY
SECURITY ADVISORY
This ADVISORY is initiated for INFORMATIONAL purposes only. The following paragraphs shall in no way be construed as a waiver by the undersigned of the rights and protections provided by COMAR (Code of Maryland Regulations) Title 11, Department of Transportation, Subtitle 2, Transportation Service Human Resources System, if applicable, and/or by law or regulation.
The Office of Information Resources, its client agencies and their customers adhere to State data processing security policies as set forth in Executive Order 01.01.1983.18 (Privacy and State Data system Security); MD Code Ann., Criminal Law Article, §§
Federal laws affecting access to and use of computer information include, but are not limited to, the following: 15 U.S.C. § 271 et seq. (National Institute of Standards and Technology); 44 U.S.C. § 3541 et seq. (Federal Information Security Management Act of 2002); 49 U.S.C. § 30301 et seq. (National Driver Register Act of 1982); 5 U.S.C. § 552 (Freedom of Information Act); 5 U.S.C. § 552a (Privacy Act of 1974); 18 U.S.C. § 1001 et seq. (Computer Fraud and Abuse Act of 1986); 17 U.S.C. § 109 (Computer Software Rental Amendments Act of 1990); 15 U.S.C. § 1681 et seq. (Fair Credit Reporting Act); 18 U.S.C. § 1030 (Computer Crime Statute of 1984); 18 U.S.C. § 2721 et seq. (Driver’s Privacy Protection Act of 1994); and Federal Copyright Law.
Specifically PROHIBITED ACTS include, but are not limited to:
1. Unauthorized access to or use of a computer, data or software.
2. Unauthorized copying or disclosure of data or software.
3. Obtaining unauthorized confidential information.
4. Unauthorized modification or altering of data or software.
5. Introduction of false information (public records).
6. Disruption or interruption of the operation of a computer.
7. Disruption of government operations or public services.
8. Denying services to authorized users.
9. Taking or destroying data or software.
10. Creating/altering a financial instrument or fund transfer.
11. Misusing or disclosing passwords.
12. Breaching a computer security system.
13. Damaging, altering, taking or destroying computer equipment or supplies.
14. Devising or executing a scheme to defraud.
15. Obtaining or controlling money, property, or services by false pretenses.
Authorized access to, including INTERNET and INTRANET, and use of information and computer resources is limited to the PURPOSE for which these privileges are granted. All authorized users during the term of their access and thereafter, shall hold in strictest confidence and not willfully disclose to any person, firm or corporation without the express authorization of the Director, OIR, any information related to security, operations, techniques, procedures or any other security matters. Any breach of security will be promptly reported to the Director, Office of Information Resources, designee or security officer.
I acknowledge that I have read and understand the foregoing security advisory.
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Name: _____________________________________________ |
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(Please print or type) |
Date:___________________ |
_____________________________________________ |
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(Signature) |
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File Breakdown
| Fact Name | Description |
|---|---|
| Form Purpose | The ICD-072 form is used to request remote access to the Maryland Insurance Certifications reporting system. |
| Location of Submission | Completed forms should be mailed to the ICD Business Administrator at MVA, 6601 Ritchie Hwy, Glen Burnie, MD. |
| Required Approvals | The request may need authorization from your Insurance Company or Agency Officer. |
| Governing Laws | Related laws include Maryland Code Ann., Title 12 of the Transportation Article and COMAR Title 11. |
| Contact Information | For assistance, call 410-768-7000 or visit www.MVA.Maryland.gov. |
Guide to Using Icd 072
Filling out the ICD-072 form is essential for obtaining remote access to the Maryland Insurance Certifications (Form FR-19). The following steps will help you complete the form accurately and ensure that your request is processed without delays.
- Write the Date of Request at the top of the form.
- Fill out the section labeled Insurer, listing each insurance company you are authorized to issue Maryland Insurance Certifications for.
- Sign and date the Sign Date section.
- Select one action from the boxes provided: New Request, Account Change, Account Deletion, Add Insurer Association, or Remove Insurer Association.
- In the USERID field, enter your assigned user ID.
- Provide your Producer License Number issued by the Maryland Insurance Administration.
- Fill in your name as MD Insurance Agent: last name, first name, middle initial, and suffix.
- Include the Ins Co / Agency Name where you work.
- Complete the Address section with your agency’s details.
- Enter both the agency phone number and fax number in the appropriate fields.
- Provide your Email Address.
- List the insurers for which you are authorized to issue Maryland Insurance Certifications. Use additional sheets if you need more space for up to six insurers, including their NAIC codes.
- Read the Acknowledgment section and check that you understand your responsibilities regarding remote access.
- Sign and date at the bottom of the Requester Signature/Date section.
- Have your Insurance Company/Agency Officer complete their authorization in the designated area.
- Finally, send the completed form to the ICD Business Administrator at the MVA for the necessary approvals.
Get Answers on Icd 072
What is the ICD-072 form used for?
The ICD-072 form is a request for remote access to the Maryland Department of Transportation Motor Vehicle Administration (MDOT/MVA) network. It allows authorized insurance agents to report Maryland Insurance Certifications (Form FR-19) electronically. This digital submission simplifies processes for both the insurance agents and the MVA, fostering efficiency in handling insurance certifications.
Who needs to fill out the ICD-072 form?
This form must be completed by insurance agents or agency representatives who wish to obtain remote access for electronic filing of Maryland Insurance Certifications. It's essential for those who are authorized to issue these certifications to have this access in order to streamline their reporting tasks.
What should I include in the 'Requester’ section of the form?
In the 'Requester' section, you should provide several key details:
- Your User ID and Maryland Producer License Number.
- Your name, agency name, and contact information, including phone and email.
- A list of insurers you are authorized to issue certifications for, including their NAIC codes.
- The reason for remote access, clarifying that it is for reporting certifications electronically.
How do I submit the ICD-072 form?
Once the form is completed, you need to submit it to the ICD Business Administrator at the MVA. This can be done by mailing it to room 140 of the MDOT/MVA facility located at 6601 Ritchie Highway, Glen Burnie, Maryland. Make sure to check for any required signatures before sending it off, as incomplete forms may delay your access request.
What happens after I submit the form?
After submission, the ICD Business Administrator will review the request. If everything is in order, your request will then be forwarded to the MVA Security Officer for verification and approval of access rights. This step is crucial for ensuring that only authorized individuals have access to the sensitive MVA network.
What responsibilities do I have upon receiving access?
As a user granted remote access, you accept several important responsibilities. You must ensure that all login credentials, such as passwords and user IDs, are kept confidential. Additionally, you are also responsible for maintaining current virus protection on your device and keeping the software updated. These precautions help protect both your data and the MVA network from security threats.
What if my access needs change in the future?
If your access requirements change, such as needing to add or remove insurer associations, you must submit the ICD-072 form again, clearly indicating the required changes. This helps maintain accurate records and ensures your access rights align with your current obligations as an insurance agent.
Common mistakes
Filling out the ICD-072 form can be a straightforward process, but common mistakes often lead to delays or complications. One significant error that people make is omitting necessary information, particularly in the top section of the form. It’s crucial to list each “Insurer” company you are authorized to issue certifications for. Leaving this section incomplete may trigger processing issues and could prevent your request from moving forward.
Another frequent mistake relates to securing the required signatures. The form explicitly requires not only your signature but also that of your Insurance Company or Agency Officer. Some individuals forget to obtain this signature, assuming it is not essential. However, lacking the proper authorization will halt your request, as the MVA will not consider forms without these signatures.
Incorrectly entering identification numbers, such as the Producer License No and the Insurer NAIC Code, can also cause problems. Ensure that these numbers are accurately recorded. Small errors might seem minor, but they could lead to serious delays in processing. Verification of these details is a crucial step that shouldn’t be overlooked.
Lastly, another common oversight involves misreading the instructions for remote access acknowledgment. Applicants sometimes fail to confirm they have installed proper virus protection or do not acknowledge that keeping passwords confidential is their responsibility. These are important aspects of the process. Not paying attention to these details can lead to loss of access privileges, which affects your ability to complete future transactions efficiently.
Documents used along the form
When submitting the ICD 072 form, there are several other documents and forms that might also be required. Each of these documents plays a specific role in ensuring compliance with necessary regulations and facilitates the processing of requests related to Maryland Insurance Certifications.
- Form FR-19: This is the Maryland Insurance Certification form that is issued by agents to confirm that a vehicle is insured, often required by the Motor Vehicle Administration for vehicle registration.
- Producer License Application: This document is necessary for individuals who wish to become licensed insurance agents in Maryland, detailing their personal information and qualifications.
- Insurance Policy Documents: Documentation that outlines the specifics of an insurance policy, including coverage limits, premiums, and terms. This may be required to confirm coverage when filing Form FR-19.
- Agency Appointment Form: This form designates a specific insurance agency to represent an insurance carrier, necessary for agents to issue insurance certificates.
- Security Advisory Agreement: This agreement requires individuals to acknowledge the terms and responsibilities associated with accessing the MVA's network, essential for security compliance.
- Request for Access Form: A standalone form that individuals may need to fill out to gain access to specific electronic systems beyond basic remote access, detailing the type of access requested.
- Confidentiality Agreement: This agreement reinforces the obligation to protect sensitive information accessed through MVA systems, ensuring compliance with privacy regulations.
- Network Access Policy: A document that outlines the rules and guidelines governing the use of the Maryland MVA digital network, important for maintaining system integrity.
- Client Consent Form: Required when disclosing information about a client, this form ensures that the necessary permissions are obtained for sharing sensitive data with third parties.
- Annual Compliance Review Form: Used by insurance agencies to confirm adherence to state regulations and standards, helping maintain an active status with the MVA.
Understanding these ancillary forms can help streamline the insurance certification process. Each document serves its own purpose and contributes to a more organized submission, ultimately ensuring compliance with state regulations.
Similar forms
- Form FR-19: This form certifies Maryland insurance compliance for motor vehicle operators, similar in function to ICD-072 by serving as documentation for insurance certifications.
- MDOT Remote Access Agreement: This document outlines the terms of remote access similar to ICD-072, focusing on the responsibilities and obligations of users granted access to state systems.
- MVA Security Access Request: This form is used to request access to specific MVA systems, mirroring the access request nature found in the ICD-072.
- Producer License Application: This document allows individuals to apply for a license to sell insurance, serving a foundational role in proving eligibility, akin to the verification process in ICD-072.
- Insurer Affidavit: Similar to the ICD-072, this affidavit verifies the legitimacy of an insurance provider in Maryland, confirming their compliance with state regulations.
- Insurance Certification Form: This is a general form used to certify compliance with state insurance laws, similar in purpose to the certifications issued through ICD-072.
- Data Security Advisory: This document emphasizes the importance of data security for users, aligning with the security acknowledgment in the ICD-072 form.
- Client Authorization Form: This form collects authorization for insurance actions on clients’ behalf, reflecting the approval process included in the ICD-072.
- Agency Registration Form: Similar to ICD-072, this form registers an agency with the state, ensuring compliance and proper representation within Maryland insurance processes.
Dos and Don'ts
Things You Should Do:
- Complete the top section of the form accurately with each insurer company name.
- Clearly list your Producer License number issued by the Maryland Insurance Administration.
- Sign and date the form to confirm your request.
- Mail the completed form to the ICD Business Administrator to ensure proper processing.
- List all insurers you are authorized to issue certifications for, using additional sheets if necessary.
- Keep your access information, such as usernames and passwords, confidential at all times.
- Install virus protection software on your remote system as required.
Things You Shouldn't Do:
- Do not leave any required fields on the form blank.
- Avoid submitting the form without the necessary signatures from your insurance company or agency officer.
- Don’t share your login credentials with anyone.
- Never use the access for purposes other than those specifically authorized.
- Do not neglect to routinely update your virus protection software after installation.
- Avoid making false entries in public records.
- Do not ignore any requests for security testing of your connection to the MVA network.
Misconceptions
- Misconception 1: The ICD 072 form can be submitted without any approvals.
- Misconception 2: Only agents can fill out the ICD 072 form.
- Misconception 3: Submitting the form guarantees immediate access.
- Misconception 4: The ICD 072 form has no associated responsibilities.
- Misconception 5: Once access is granted, there's no need to monitor security protocols.
Many believe that simply filling out the ICD 072 form is enough to gain access. In reality, this form requires approval from the insurance company or agency officer before it can be processed.
While it is common for agents to complete the form, any authorized representative from the insurer can fill it out. This means that office staff or other designated individuals can also handle this task, as long as they have the appropriate authorization.
Some people think that once they submit the ICD 072, they will be granted access right away. The truth is that the request needs to be reviewed and approved by the MVA Security Officer, which might take time.
Individuals often overlook the fact that requesting remote access involves significant responsibilities, such as maintaining the confidentiality of passwords and ensuring the installation of virus protection software. Failure to comply can lead to a loss of access privileges.
Some mistakenly believe that after receiving access, they are set for life. However, it is essential to regularly monitor and follow security protocols outlined in the form. It's a ongoing obligation to ensure compliance with security measures.
Key takeaways
Ensure that the ICD-072 form is filled out completely, especially the requester section, which includes all necessary information about insurers you are authorized to issue certifications for.
Approvals may be required from your Insurance Company or Agency Officer before submitting the form. Be prepared to wait for this authorization to avoid delays.
The form must be sent via mail to the ICD Business Administrator at the Maryland Motor Vehicle Administration (MVA) for an authorization signature.
Indicate the action you are requesting: whether it is a new request, an account change, account deletion, or adjustments to insurer associations. Check the appropriate box.
Remote access is a privilege, and keeping your credentials confidential is essential. By submitting this form, you acknowledge your responsibility for maintaining security practices, such as virus protection on your system.