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What information do I need to put on the form?

What information do I need to put on the form?

www.cms.gov

Authorization Agreement for Preauthorized Payments form (SF-5510), and indicate the type of change you want to make on the form. Mail the completed form to the address above. It can take 6 to 8 weeks to change your bank account. You can get a new form at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

  Form, Agreement, Payments, Authorization, Authorization agreement, Payments form

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