APPLICATION FOR ACCESS TO CMS COMPUTER SYSTEMS
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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