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Get and Sign 0990 0243 Form

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Healthcare Provider Information CMS Medicare Provider Number: Name of Facility: Address: Street Number and Name City or Town Administrator’s Name: Telephone: ( FAX: ( Type of Facility: Corporate Affiliation: State or Province ) ) - Contact Person: TDD: E-mail: Zip Code ( ) - Number of employees: ________________________________ Reason for Application: Circle One Initial Medicare Certification or Change of Ownership II. Documents Required for Submission Additional guidance is...
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Instructions and help about sde form 0990

When creating a new user it is important to know whether the user is a business partner CMS employee of another federal agency contractor or researcher while some information like name and SSN are required for all user types each of the major user types need unique information this chart shows the unique information required by ID type for example researcher ID type requires a grant number to be included in the application new users requiring access to CMS systems must first complete an HHS seven four five form and submit it to their CAA the CIA will then log on to the EU a system to create a new user once logged into the EU a system expand the account management tab on the left side menu select user accounts and then click create identity on the create identity screen enter the users' information as provided on the HHS seven four five form you may need to browse to find the admin code company name or contract number clicking browse will take you to the search screen once at the search

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