The Medical Cannabis - Change of Information Form is the form the DC Alcoholic Beverage and Cannabis Administration (ABCA) uses to record a change in a registered patient's or caregiver's name, address, caregiver or recommending physician. It is a Medical Cannabis Program form, not a business license application. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the form and its submission channels are published by ABCA at abca.dc.gov.
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What is Medical Cannabis - Change of Information Form – Washington, DC?
The Medical Cannabis Change of Information Form is the Alcoholic Beverage and Cannabis Administration (ABCA) form that a patient with a registration identification card, or a registered caregiver, submits to report a change in name, address, caregiver or recommending physician in the District of Columbia's Medical Cannabis Program.
The form opens with a box for your name, date of birth and registration number as they appear on your registration card, and a choice between Patient and Caregiver. It then has four sections, and you check the one you want to change:
- Change Name: enter the new name (first, middle initial, last).
- Remove Caregiver: a patient states that he or she no longer wishes to be registered with the current caregiver. A person named as a new caregiver must complete a Caregiver Application.
- Change Address: enter the complete new street address, apartment or suite, city, state and ZIP code. P.O. boxes are not acceptable.
- Change Physician: enter the new physician's name and DC Medical License Number. New physicians must complete Physician Recommendation Forms.
The form closes with an initialed certification, one for patients and one for caregivers, followed by a signature and date. Processing a change results in a new registration card that reflects it, and the current card is surrendered. The form is not an application to join the program and does not designate a new caregiver.
Who needs to file Medical Cannabis - Change of Information Form – Washington, DC?
Patients who have been issued a registration identification card use this form to report a change in their name, address, caregiver or recommending physician.
Registered caregivers use it too. When a caregiver receives notice of a patient's change of name, address or recommending physician, the caregiver submits a written request for a new registration identification card using this form.
Limits stated on the form:
- A patient who wants a different caregiver uses the Remove Caregiver section; the new person must complete a Caregiver Application.
- A patient who changes physicians must make sure the new physician completes Physician Recommendation Forms.
- A change of address requires a street address; P.O. boxes are not acceptable.
The ABCA fee notice also lists withdrawing from the Medical Cannabis Program among the changes that carry no fee. The form itself offers only the four change sections described above.
When to file Medical Cannabis - Change of Information Form – Washington, DC
Submit the form within fourteen (14) calendar days of any change in a patient's name, address, caregiver or recommending physician. The patient who holds a registration identification card carries this duty.
A registered caregiver has the same 14-calendar-day window, counted from the date the caregiver receives notice of the patient's change of name, address or recommending physician.
The initialed certification on the form repeats the rule: the patient must notify ABCA in writing within 14 calendar days of any of these changes, surrender the current registration identification card, pay the required fee where one applies, and will be issued a new card that reflects the changes. The form prints no other deadline and no processing time.
Documents you need
- Name change: a copy of your certificate of marriage, divorce decree, or court order that authorizes the name change.
- Address change: at least one original primary-source proof-of-residency document; any one of the listed documents is accepted.
- Utility bill (water, gas, electric, oil or cable) with the applicant's name and address, issued within the last sixty (60) days.
- Telephone bill reflecting the applicant's name and current address, issued within the last sixty (60) days; cell phone, wireless and pager bills are not acceptable.
- Deed or settlement agreement in the applicant's name reflecting the property address.
- Unexpired lease or rental agreement listing the applicant as lessee, permitted resident or renter; a photocopy is allowed.
- DC Property Tax bill, or an unexpired homeowner's insurance policy reflecting your name and address.
- Letter with picture from the Court Services and Offender Supervision Agency (CSOSA) or the DC Department of Corrections certifying name and residence.
- DC DMV Proof of Residency Form signed by the person who owns the residence, with a copy of that person's unexpired DC driver license or DC identification card and one of the primary sources above in that person's name.
- Physician change: Physician Recommendation Forms completed by the new physician.
How to fill out Medical Cannabis - Change of Information Form – Washington, DC
Enter your identifying information
In the box at the top, write your name, date of birth and registration number exactly as they appear on your registration card.
Select patient or caregiver
Next to I am a: check Patient or Caregiver, depending on who is submitting the change.
Complete Change Name if needed
Check Change Name and enter the NEW name as first name, middle initial and last name. Enclose a copy of the marriage certificate, divorce decree or court order.
Complete Remove Caregiver if needed
Check Remove Caregiver if you no longer wish to be registered with your current caregiver. A new caregiver must complete a Caregiver Application.
Complete Change Address if needed
Check Change Address and enter the new street, apartment or suite, city, state and ZIP code. Do not use a P.O. box, and attach one proof-of-residency document.
Complete Change Physician if needed
Check Change Physician and enter the NEW physician's name and DC Medical License Number. The new physician must complete Physician Recommendation Forms.
Initial the certification
Patients initial the patient statement and caregivers initial the caregiver statement. Each confirms the 14-calendar-day rule, surrender of the current card and that the information is true and accurate.
Sign and date the form
Enter your signature and the date of signature at the bottom of the form.
Review and download the completed PDF
Check your registration number, the section you changed and the attachments. Download or print the completed PDF from FillingPDF and send it as described under How to submit.
How to submit Medical Cannabis - Change of Information Form – Washington, DC
ABCA accepts the completed form by mail, by drop-off in person, or by email.
- Mail or in person: ABCA, Medical Cannabis Program, 899 North Capitol Street, NE, Suite 4200B, Washington, DC 20002.
- Email: [email protected].
Include the documents that match your change: a copy of the marriage certificate, divorce decree or court order for a name change, and an original proof-of-residency document for an address change.
A fee applies to most changes. Changing a patient or caregiver home address, removing a caregiver and withdrawing from the program carry no fee. For other changes there is a fee to replace the registration card, and a reduced fee for registrants whose income is at or below 200% of the federal poverty level. Fees may be paid by credit or debit card, check, certified check or cashier's check; make checks payable to the DC Treasurer. Ask ABCA for current amounts.
The form's certification also says you surrender your current registration identification card. FillingPDF lets you fill out and download the PDF; submission follows the ABCA channels above.
Common mistakes to avoid
- Submitting the form after the fourteen (14) calendar days allowed following a change of name, address, caregiver or recommending physician.
- Entering a P.O. box as the new street address; the form says P.O. boxes are not acceptable.
- Using a cell phone, wireless or pager bill as proof of residency; only a regular telephone bill is accepted.
- Attaching a utility or telephone bill issued more than sixty (60) days ago.
- Sending a name change without a copy of the marriage certificate, divorce decree or court order authorizing it.
- Writing a check to anyone other than the DC Treasurer when a fee applies.
- Leaving the patient or caregiver certification uninitialed, or omitting the signature and date.
- Listing a new physician without the Physician Recommendation Forms the new physician must complete.
- Naming a new caregiver on this form; that person must complete a Caregiver Application.
Frequently asked questions
What is the Medical Cannabis Change of Information Form?
It is the ABCA form a registered patient or caregiver submits to report a change in name, address, caregiver or recommending physician. ABCA then issues a new registration card that reflects the change, after the current card is surrendered.
How long do I have to report a change to ABCA?
Fourteen (14) calendar days. Patients count from the change itself; registered caregivers count from the day they receive notice of the patient's change of name, address or recommending physician.
Is there a fee to change my address on a medical cannabis card?
No. ABCA lists a change of patient or caregiver home address, removing a caregiver and withdrawing from the program as no-fee changes. Other changes carry a card replacement fee, with a reduced fee at or below 200% of the federal poverty level.
What proof do I need to change my address?
At least one original primary-source document, such as a recent utility bill, a deed, an unexpired lease, a DC Property Tax bill or an unexpired homeowner's insurance policy. Bills must be issued within the last 60 days, and cell phone bills are not accepted.
Where do I send the Medical Cannabis Change of Information Form?
Mail or deliver it to ABCA, Medical Cannabis Program, 899 North Capitol Street, NE, Suite 4200B, Washington, DC 20002, or email it to [email protected]. Include the documents that match your change.
What do I need to change my name on my registration card?
Enclose a copy of your marriage certificate, divorce decree or a court order authorizing the name change, and enter your new name in the Change Name section. A fee may apply, payable to the DC Treasurer if paying by check.
How do I add a new caregiver or physician?
This form removes a caregiver or lists a new physician; it does not add a caregiver. A new caregiver must complete a Caregiver Application, and a new physician must complete Physician Recommendation Forms.
Can I fill out this form online on FillingPDF?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is independent of ABCA and does not submit the form; you send it to ABCA by mail, in person or by email.
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