A. Each licensee shall submit a report of authorized delegates within forty-five days after the end of the calendar quarter. The director may use NMLS for the submission of the report required by this subsection if functionality complies with this section.

B. The authorized delegate report shall include the following information for each authorized delegate:

1. The company legal name.

2. The taxpayer employer identification number.

3. The principal provider identifier.

4. The physical address, if any.

5. The mailing address.

6. Any business conducted in other states.

7. Any fictitious or trade name.

8. The contact person name, telephone number and email address.

9. The start date as the licensee’s authorized delegate.

10. The end date as the licensee’s authorized delegate, if applicable.

11. Any other information the director reasonably requires with respect to the authorized delegate.