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US · guidance

CMS Pub. 100-08, ch. 10, § 10.3.3

Other Enrollment Forms: Information and Processing

activein force · 2026-08-25 – presentas-observed

The forms or form types described in this section 10.3.3 et seq. are routinely submitted with

an enrollment application.

For purposes of sections 10.3.3.1 and 10.3.3.2, all references to the Form CMS-855 include

the Form CMS-20134, unless otherwise stated.

History

(Rev. 10868; Issued: 07-14-21; Effective: 08-13-21; Implementation: 08-13-21)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
c9f301de2dc17dfc6575e8b953f1ba9c9ba9a5c3e63b832fe2c0fc5b71a3fede
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