An approved Agency Group Administrator (AGA) is required to register an insurance agency for access to the DCRB/PCRB Application Manager and the products contained therein. The AGA will be responsible for establishing and maintaining contact information and authorization for all user access for their Agency Group. The AGA will have the authority to view and control access for all users and applications.

The Agency Group Administrator must be appointed by the agency’s authorizing officer. The authorizing officer must be a controlling member of the organization, such as the President, Owner or Officer.

AUTHORZING OFFICER

Name:*

Title:*

Email:*

An approved Employer Group Administrator (EGA) is required to register an employer for access to the DCRB/PCRB Application Manager and the products contained therein. The EGA will be responsible for establishing and maintaining contact information and authorization for all user access for their Employer Group. The EGA will have the authority to view and control access for all users and applications.

The Employer Group Administrator must be appointed by the company’s authorizing officer. The authorizing officer must be a controlling member of the organization, such as the President, Owner or Officer.

AUTHORZING OFFICER

Name:*

Title:*

Email:*