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NCIA Insurance Agency
840 1st NE
Washington, DC 20065
Tel. 202-680-7077
Fax. 202-680-7644


The electronic NCIA Enrollment Change Form is currently unavailable. Please submit your enrollment terminations
or salary changes by clicking on the link below and printing a copy of the attached form and faxing it to NCIA at
(202) 680-7644. If you have any questions, please call (202) 680-7076. Thank you.


NCIA Enrollment Change Form

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Adobe site.


Changes received in our office by the fifth of the month will be reflected on the next invoice.