Fillable Online TVFC Program - Vaccine Transfer Authorization Form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section A, where you will enter your original facility information, including the PIN, today's date, and the original facility name along with the vaccine delivery address.
3. If applicable, check the box for any changes in Sections B through H. For example, if changing the facility name, fill in the new name in Section B while adhering to character limits.
4. In Section C, provide the new shipping address details. Ensure accuracy as this is crucial for vaccine deliveries.
5. For Section D, indicate your shipping hours by filling out the table with available times for receiving shipments. Remember to specify AM or PM.
6. Complete Sections E and F by entering details of the new signing clinician and any changes in prescribing authorities respectively.
7. In Section G, report patient population data accurately based on previous year’s records. Use provided tables for clarity.
8. Finally, update any changes regarding primary and back-up vaccine coordinators in Section H before submitting your form.

Start using our platform today to streamline your form completion process for free!