1. Each licensee shall submit a report of authorized delegates within forty-five days of the end of the calendar quarter. The director is authorized to utilize NMLS for the submission of the report required under this section, provided that such functionality is consistent with the requirements of this section.
2. The authorized delegate report shall include, at a minimum, each authorized delegate's:
(1) Company legal name;
(2) Taxpayer employer identification number;
(3) Principal provider identifier;
(4) Physical address, if any;
(5) Mailing address;
(6) Any business conducted in other states;
(7) Any fictitious or trade name;
(8) Contact person name, phone number, and email;
(9) Start date as licensee's authorized delegate;
(10) End date acting as licensee's authorized delegate, if applicable; and
(11) Any other information the director reasonably requires with respect to the authorized delegate.