CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement
The CMS-588 form is the Electronic Funds Transfer (EFT) Authorization Agreement form, used by healthcare providers to authorize electronic payments from Medicare to their designated bank account.
CMS-855O Medicare Enrollment Application
The CMS-855O Medicare Enrollment Application is a form used to enroll in Medicare as an individual or group practice opting out of the Medicare program.
IRS Form 1023. Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code
IRS Form 1023 is an application for tax exemption under section 501(c)(3) of the Internal Revenue Code in the United States. This form is used by nonprofit organizations to apply for tax-exempt status from federal income tax.
CMS-416 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Health Assessment Form
The CMS-416 form, also known as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Health Assessment Form, is used to document the results of a comprehensive health assessment for children under the age of 21 who are enrolled in the Medicaid program.
CMS-855S Medicare Enrollment Application
The CMS-855S is a Medicare Enrollment Application used by suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) to enroll in the Medicare program or make changes to an existing enrollment record.
CMS-855B Medicare Enrollment Application
The CMS-855B is a Medicare Enrollment Application for clinics, group practices, and certain other suppliers who wish to enroll in Medicare.
CMS-855R Medicare Enrollment Application
The CMS-855R is a Medicare Enrollment Application for physicians and non-physician practitioners who are reassigning their Medicare benefits to a group or an organization.
CMS-855I Medicare Enrollment Application
CMS-855I is the Medicare Enrollment Application for Individual Practitioners. It is used by healthcare providers who are applying to become Medicare providers or who are making changes to their Medicare enrollment information.
FDA Form 1572 Statement of Investigator
FDA Form 1572, also known as the Statement of Investigator, is a form used by the U.S. Food and Drug Administration (FDA) to document that an investigator who is conducting a clinical trial has agreed to follow the regulations governing the study.
VA Form 10-10EZ. Application for Health Benefits
VA Form 10-10EZ is the Health Benefits Renewal Form which is used to renew your enrollment for VA Health Benefits. It is used to update your personal, insurance, and financial information to ensure that your healthcare benefits are up-to-date.