CMS and Medicare Forms
Official-source Centers for Medicare and Medicaid Services forms for Medicare enrollment, claims, provider, coverage, appeals, quality, and beneficiary workflows.
Use current official-source forms
These pages prioritize forms with government or issuing-authority sources, source links, PDF workflows, and clear filing context. Always confirm final filing rules, fees, and submission channels with the official source.
Before filing
- Confirm the CMS form number, revision date, and program before completing the PDF.
- Review Medicare, Medicaid, provider, plan, or beneficiary instructions for where to submit the form.
- Keep copies of claim, enrollment, authorization, appeal, or supporting medical documents.
141 CMS Forms
Page 2 of 6
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.
Form CMS 1557(2021)
SURVEY REPORT FORM - CLIA
Official Centers for Medicare & Medicaid Services CMS 1557 for SURVEY REPORT FORM - CLIA, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 1561(2025)
HEALTH INSURANCE BENEFIT AGREEMENT
Official Centers for Medicare & Medicaid Services CMS 1561 for HEALTH INSURANCE BENEFIT AGREEMENT, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 1561A(2025)
HEALTH INSURANCE BENEFIT AGREEMENT-RURAL HEALTH CLINIC
Official Centers for Medicare & Medicaid Services CMS 1561A for HEALTH INSURANCE BENEFIT AGREEMENT-RURAL HEALTH CLINIC, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 1563(1997)
Monthly Intermediary Report on Medicare Secondary Payer Savings
Official Centers for Medicare & Medicaid Services CMS 1563 for Monthly Intermediary Report on Medicare Secondary Payer Savings, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 1564(1997)
MONTHLY CARRIER REPORT ON MEDICARE SECONDARY PAYER SAVINGS
Official Centers for Medicare & Medicaid Services CMS 1564 for MONTHLY CARRIER REPORT ON MEDICARE SECONDARY PAYER SAVINGS, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 1572(2022)
HHA SURVEY REPORT
Official Centers for Medicare & Medicaid Services CMS 1572 for HHA SURVEY REPORT, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 1666(1980)
REGIONAL OFFICE REQUEST FOR ADDITIONAL INFORMATION
Official Centers for Medicare & Medicaid Services CMS 1666 for REGIONAL OFFICE REQUEST FOR ADDITIONAL INFORMATION, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 1696(2026)
APPOINTMENT OF REPRESENTATIVE
Official Centers for Medicare & Medicaid Services CMS 1696 for APPOINTMENT OF REPRESENTATIVE, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 1771(1977)
ATTENDING PHYSICIANS STATEMENT AND DOCUMENTATION FOR MEDICARE EMERGENCY
Official Centers for Medicare & Medicaid Services CMS 1771 for ATTENDING PHYSICIANS STATEMENT AND DOCUMENTATION FOR MEDICARE EMERGENCY, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 179(2024)
TRANSMITTAL AND NOTICE OF APPROVAL OF STATE PLAN MATERIAL
Official Centers for Medicare & Medicaid Services CMS 179 for TRANSMITTAL AND NOTICE OF APPROVAL OF STATE PLAN MATERIAL, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 1856(2006)
Request for Certification in the Medicare and/or Medicaid Program to Provide Outpatient Physical Therapy and/or Speech Pathology Services
Official Centers for Medicare & Medicaid Services CMS 1856 for Request for Certification in the Medicare and/or Medicaid Program to Provide Outpatient Physical Therapy and/or Speech Pathology Services, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage,...
Form CMS 1880(2018)
REQUEST FOR CERTIFICATION AS SUPPLIER OF PORTABLE XRAY SERVICES
Official Centers for Medicare & Medicaid Services CMS 1880 for REQUEST FOR CERTIFICATION AS SUPPLIER OF PORTABLE XRAY SERVICES, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 1882(2009)
PORTABLE XRAY SURVEY REPORT
Official Centers for Medicare & Medicaid Services CMS 1882 for PORTABLE XRAY SURVEY REPORT, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 1980(1978)
CARRIER OR INTERMEDIARY REQUEST FOR SSO ASSISTANCE
Official Centers for Medicare & Medicaid Services CMS 1980 for CARRIER OR INTERMEDIARY REQUEST FOR SSO ASSISTANCE, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 20017(2017)
ADVISORY PANEL ON HOSPITAL OUTPATIENT PAYMENT
Official Centers for Medicare & Medicaid Services CMS 20017 for ADVISORY PANEL ON HOSPITAL OUTPATIENT PAYMENT, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 20027(2026)
MEDICARE REDETERMINATION REQUEST FORM
Official Centers for Medicare & Medicaid Services CMS 20027 for MEDICARE REDETERMINATION REQUEST FORM, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 20031(2018)
TRANSFER (ASSIGNMENT) OF APPEAL RIGHTS
Official Centers for Medicare & Medicaid Services CMS 20031 for TRANSFER (ASSIGNMENT) OF APPEAL RIGHTS, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 20033(2026)
MEDICARE RECONSIDERATION REQUEST FORM
Official Centers for Medicare & Medicaid Services CMS 20033 for MEDICARE RECONSIDERATION REQUEST FORM, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 20037(2010)
APPLICATION FOR ACCESS TO CMS COMPUTER SYSTEMS
Official Centers for Medicare & Medicaid Services CMS 20037 for APPLICATION FOR ACCESS TO CMS COMPUTER SYSTEMS, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 20040(2026)
Regional Office Meeting/Speaker Request Form
Official Centers for Medicare & Medicaid Services CMS 20040 for Regional Office Meeting/Speaker Request Form, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 20041(2026)
Speech Invitation Request Background Information
Official Centers for Medicare & Medicaid Services CMS 20041 for Speech Invitation Request Background Information, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS 2007(1982)
PROVIDER TIE IN NOTICE
Official Centers for Medicare & Medicaid Services CMS 2007 for PROVIDER TIE IN NOTICE, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.