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APPLICATION FOR ACCESS TO CMS COMPUTER SYSTEMS

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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