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APPLICATION FOR ACCESS TO CMS COMPUTER SYSTEMS

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R4 (AFC) Atlanta R10 (BLNCH) Seattle CO (CENTRAL) Central Office R5 (CHIICB) Chicago DC (COHEN) DC R6 (DAL1301) Dallas R8 (DENCSB) Denver R7 (FOBKAN) kansas City Form CMS-20037 (06/10) Mail Stop Desk Location DEPARTMENT OF HEALTH AND HUMAN services CENTERS FOR medicare & medicaid services EUA WorkFlow Request No.

R7 (FOBKAN) Kansas City Form CMS-20037 (06/10) Mail Stop Desk Location DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES EUA WorkFlow Request No. APPLICATION FOR ACCESS TO CMS COMPUTER SYSTEMS (Due date: _____/_____) 1. TYPE OF REQUEST (Check only one): NEW mo yr USERID

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