Greetings RBWO Providers,

As we continue to review your submitted FY 23 contract documents, we will be communicating any needed updates as we become aware of them.  Thank you for your continued cooperation as we move through this process!  Attached is an updated copy of the Authorized Signer & Approval Information Form. We understand that many of you have already completed and uploaded this form in GA SCORE, however, there are a few corrections needed from many of you. We ask that each of you utilize the attached form and ensure that the following instructions are followed when completing this form:

1. In the Authorized Signer section, please List ONLY the person(s) identified in your Corporate Resolution as the approved person(s) to sign your DHS-Room Board and Watchful Oversight (RBWO) contract.  Please do not list any additional names that are not listed on the Corporate Resolution. Please ensure that the Authorized Signer’s title, email address and phone number are correct. This is critical to ensuring that your contract is sent to the correct individual for signing. 
2. The Program Contact Section at the bottom should be left blank.  This section is specifically for the Office of the Provider Management (OPM) internal use.
3. Please save the form as an editable PDF as the form must be signed by OPM in the Program Contact section.

Please take a moment to update your Authorized Signer & Approval Information Form to ensure that it is accurate.  Please upload the updated form by close of business Wednesday, February 16, 2022. If you have any questions, please email Brenda.Jones@dhs.ga.gov .

Thank you in advance,

The Office of Provider Management