ROMI/MAF Request & Submission Form

ROMI/MAF Request & Submission Form

As an employee participating in the Employee Donation Program, please use this form to request and submit documentation related to your MAF deferral. 
Instructions:
To submit a completed ROMI or MAF, select Center Employee, submitting a form delivered to the center.
- Use your name, personal email, and personal phone number on the Donor Information page
- Enter SELF in the last name field on the document submission page
- Upload your documentation
- Review the acknowledgements, sign the form, & submit!

To have Corporate Medical send you a ROMI and or send a MAF on your behalf, select Donor, requesting PCP follow up be done electronically on my behalf.
- Use your name, personal email, and personal phone number on the Donor Information page
- Complete the PCP or Provider's Information page
- Review the acknowledgements, sign the form, & submit!
* If you have not uploaded & submitted a ROMI prior to sending your PCP's info, a ROMI will be sent to the email address on file.



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