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OMB Approved No. 2900-0846 Respondent Burden: 15 Minutes Expiration Date: 07-31-2019 VA-FSC VENDOR FILE REQUEST FORM NEW DATE UPDATE VA FACILITY INFORMATION PAYEE/VENDOR INFORMATION STATION NUMBER COMMERCIAL VENDOR REGISTERED IN SAM.GOV (Required IAW FAR 4.1102) STATION CONTACT DUNS NUMBER STATION PHONE NUMBER STATION FAX NUMBER STATION EMAIL ADDRESS DUNS+4 SSN/TIN PAYEE/VENDOR TYPE (Select one) NPI C - COMMERCIAL F - FEDERAL AGENCY E - EMPLOYEE O - FOREIGN FACTS ID I - INDIV.

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