Centers for Medicare and Medicaid Services Forms
Browse source-backed centers for medicare and medicaid services forms with fillable PDF workflows, official source links, and filing context for common document tasks.
Use current CMS forms
These listings prioritize indexable, source-backed form pages with clear descriptions and official filing context. Confirm the final submission method with the issuing source before sending sensitive information.
Filing checklist
- Confirm the current CMS form edition before filing.
- Review official instructions for fees, deadlines, signatures, and submission channels.
- Keep a copy of the completed PDF and any official confirmation or receipt.
136 CMS Forms
Page 1 of 6
CMS-10106(2026)
1-800-Medicare Authorization to Disclose Personal Health Information
Medicare authorization form allowing CMS to disclose a beneficiary personal health information to a selected person or organization.
CMS-1490S(2021)
Patient's Request for Medical Payment
Medicare beneficiary claim form used to request payment when a provider or supplier did not file a Medicare claim.
CMS-1763(2022)
Request for Termination of Premium Part A, Part B, or Part B Immunosuppressive Drug Coverage
Medicare form used to request voluntary termination of premium Part A, Part B, or Part B immunosuppressive drug coverage.
CMS-18-F-5(2025)
Application for Medicare Part A (Hospital Insurance)
Medicare application for people age 65 or older, or turning 65 within 3 months, who want to apply for Part A hospital coverage.
CMS-40B(2025)
Application for Enrollment in Medicare Part B (Medical Insurance)
Centers for Medicare & Medicaid Services form used by eligible people with Medicare Part A to request enrollment in Medicare Part B.
CMS-43(2024)
Application for Part A and Part B for People with End-Stage Renal Disease
Medicare enrollment application for people with End-Stage Renal Disease applying for Part A and Part B coverage.
CMS-L564(2025)
Request for Employment Information
Centers for Medicare & Medicaid Services form used to document group health plan employment information for certain Medicare special enrollment requests.
Form CMS 10003-NDMCP(2013)
NOTICE OF DENIAL OF MEDICAL COVERAGE/PAYMENT ("INTEGRATED DENIAL NOTICE")
Official Centers for Medicare & Medicaid Services CMS 10003-NDMCP for NOTICE OF DENIAL OF MEDICAL COVERAGE/PAYMENT ("INTEGRATED DENIAL NOTICE"), sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 10036(2006)
Inpatient Rehabilitation Facility-Patient Assessment Instrument
Official Centers for Medicare & Medicaid Services CMS 10036 for Inpatient Rehabilitation Facility-Patient Assessment Instrument, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 10069(2013)
Medicare Waiver Demonstration Application
Official Centers for Medicare & Medicaid Services CMS 10069 for Medicare Waiver Demonstration Application, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 10114(2025)
NATIONAL PROVIDER IDENTIFIER (NPI) APPLICATION/UPDATE FORM
Official Centers for Medicare & Medicaid Services CMS 10114 for NATIONAL PROVIDER IDENTIFIER (NPI) APPLICATION/UPDATE FORM, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 10125(2017)
DME Information Form - External Infusion Pumps DME 09.03
Official Centers for Medicare & Medicaid Services CMS 10125 for DME Information Form - External Infusion Pumps DME 09.03, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 10126(2017)
DME Information Form - Enteral and Parenteral Nutrition DME 10.03
Official Centers for Medicare & Medicaid Services CMS 10126 for DME Information Form - Enteral and Parenteral Nutrition DME 10.03, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 10164(2024)
Centers for Medicare and Medicaid Services EDI Registration Form; and EDI Enrollment Form
Official Centers for Medicare & Medicaid Services CMS 10164 for Centers for Medicare and Medicaid Services EDI Registration Form; and EDI Enrollment Form, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 10175(2022)
Electronic File Interchange Organization (EFIO) Certification Statement
Official Centers for Medicare & Medicaid Services CMS 10175 for Electronic File Interchange Organization (EFIO) Certification Statement, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 10221(2024)
Independent Diagnostic Testing Facilities-Site Investigation
Official Centers for Medicare & Medicaid Services CMS 10221 for Independent Diagnostic Testing Facilities-Site Investigation, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 10252(2022)
DATA USE AGREEMENT (DUA) CERTFICATE OF DISPOSITION (COD) FOR DATA ACQUIRED FROM THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)
Official Centers for Medicare & Medicaid Services CMS 10252 for DATA USE AGREEMENT (DUA) CERTFICATE OF DISPOSITION (COD) FOR DATA ACQUIRED FROM THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS), sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and...
Form CMS 10269(2009)
CMN Positive Airway Pressure (PAP)Devices for Obstructive Sleep Apnea
Official Centers for Medicare & Medicaid Services CMS 10269 for CMN Positive Airway Pressure (PAP)Devices for Obstructive Sleep Apnea, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 10287(2015)
Medicare Quality of Care Complaint Form
Official Centers for Medicare & Medicaid Services CMS 10287 for Medicare Quality of Care Complaint Form, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 10798(2023)
Application for Enrollment in Part B Immunosuppressive Drug Coverage
Official Centers for Medicare & Medicaid Services CMS 10798 for Application for Enrollment in Part B Immunosuppressive Drug Coverage, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 10883(2024)
ADA Dental Claim Form
Official Centers for Medicare & Medicaid Services CMS 10883 for ADA Dental Claim Form, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 116(2027)
CLINICAL LABORATORY IMPROVEMENT AMENDMENTS OF 1988 (CLIA) APPLICATION FOR CERTIFICATION
Official Centers for Medicare & Medicaid Services CMS 116 for CLINICAL LABORATORY IMPROVEMENT AMENDMENTS OF 1988 (CLIA) APPLICATION FOR CERTIFICATION, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 1539(1984)
MEDICARE/MEDICAID CERTIFICATION AND TRANSMITTAL
Official Centers for Medicare & Medicaid Services CMS 1539 for MEDICARE/MEDICAID CERTIFICATION AND TRANSMITTAL, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 1541B(2014)
RESPONSIBILITIES OF MEDICARE PARTICIPATING HOSPITALS IN EMERGENCY CASES INVESTIGATION REPORT
Official Centers for Medicare & Medicaid Services CMS 1541B for RESPONSIBILITIES OF MEDICARE PARTICIPATING HOSPITALS IN EMERGENCY CASES INVESTIGATION REPORT, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.