Use this form to submit documentation for the compliance section of the disaffiliation process (step 5).
- Multiple submissions of the form are permitted.
- One or more items may be completed with each form submission.
- Respond only to the items you are addressing with this submission (leave others blank).
- “Yes” responses may require further action (i.e. entering data or adding documents).
Need help? View the instructions.
The Disaffiliation Compliance form is now closed for the current disaffiliation window. If you have compliance items to submit, please email them directly to the Disaffiliation Team at disaffiliation@nccumc.org. Compliance questions can also be sent to that address.