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155

Form IHS-969 "Certificate of Records Destruction"

Rate (4.8 / 5) 10 votes
Size: 1 MB
2 pages

Form IHS-978 "Records Contact Designation"

Rate (4.6 / 5) 9 votes
Size: 1 MB
1 page

Form CMS-40B "Application for Enrollment in Medicare Part B (Medical Insurance)"

Rate (4.4 / 5) 42 votes
Size: 74 KB
4 pages

This application is supposed to be used by individuals when they want to apply for enrollment in Medicare Part B, insurance which provides outpatient medical coverage.

Formulario CMS-40B "Solicitud De Inscripcion Para Medicare Parte B (Seguro Medico)" (Spanish)

Rate (4.4 / 5) 104 votes
Size: 80 KB
4 pages

Form HHS-691 "Request for Title 38 Physician, Dentist and Podiatrist Pay (Pdp)"

Rate (4.6 / 5) 96 votes
Size: 1 MB
1 page

Form CMS-588 "Electronic Funds Transfer (Eft) Authorization Agreement"

Rate (4.5 / 5) 25 votes
Size: 84 KB
3 pages

Form CMS-802 "Matrix for Providers"

Rate (4.6 / 5) 62 votes
Size: 134 KB
2 pages

Form HHS-697 "Foreign Activities Questionnaire"

Rate (4.8 / 5) 93 votes
Size: 1 MB
2 pages

Form CMS-847 "Certificate of Medical Necessity - Osteogenesis Stimulators"

Rate (4.5 / 5) 65 votes
Size: 199 KB
2 pages

Form CMS-848 "Certificate of Medical Necessity - Transcutaneous Electrical Nerve Stimulator (Tens)"

Rate (4.3 / 5) 86 votes
Size: 132 KB
2 pages

Form CMS-854 "Certificate of Medical Necessity - Continuation Form"

Rate (4.8 / 5) 67 votes
Size: 128 KB
2 pages

Form CMS-846 "Certificate of Medical Necessity - Pneumatic Compression Devices"

Rate (4.8 / 5) 52 votes
Size: 122 KB
2 pages

Form CMS-849 "Certificate of Medical Necessity - Seat Lift Mechanisms"

Rate (4.3 / 5) 89 votes
Size: 153 KB
2 pages

Form HHS-419 "Clearance of Employees for Separation or Transfer"

Rate (4.7 / 5) 60 votes
Size: 1 MB
6 pages

Form HHS-700 "Civil Rights Discrimination Complaint"

Rate (4.6 / 5) 49 votes
Size: 179 KB
8 pages

Form CMS-116 "Clinical Laboratory Improvement Amendments (Clia) Application for Certification"

Rate (4.6 / 5) 48 votes
Size: 298 KB
10 pages

Form OMHA-100 "Request for Administrative Law Judge (Alj) Hearing or Review of Dismissal"

Rate (4.5 / 5) 82 votes
Size: 1 MB
2 pages

Form OMHA-119 "Withdrawal of Request for Administrative Law Judge (Alj) Hearing or Review of Dimissal"

Rate (4.5 / 5) 74 votes
Size: 1 MB
1 page

Form CMS-804 "Kitchen/Food Service Observation"

Rate (4.3 / 5) 44 votes
Size: 184 KB
2 pages

Form HHS-690 "Assurance of Compliance"

Rate (4.5 / 5) 69 votes
Size: 1 MB
1 page

Form PHS-838 "Commissioned Officers' Effectiveness Report"

Rate (4.8 / 5) 88 votes
Size: 1 MB
7 pages

Form HHS568 "Final Invention Statement and Certification"

Rate (4.4 / 5) 48 votes
Size: 1 MB
2 pages

Form HHS-520 "Request for Approval of Outside Activity"

Rate (4.7 / 5) 38 votes
Size: 2 MB
16 pages

Form HHS-521 "Annual Report of Outside Activity"

Rate (4.7 / 5) 69 votes
Size: 1 MB
10 pages

Form HHS-734 "Payment Information Report"

Rate (4.8 / 5) 33 votes
Size: 1 MB
1 page

Form HHS-719 "Request for Copy of the Record(S) in the Case File"

Rate (4.3 / 5) 73 votes
Size: 1 MB
3 pages

Form HHS-724 "Request to Correct, Amend, or Delete a Record(S)"

Rate (4.3 / 5) 34 votes
Size: 234 KB
1 page

Form HHS-720 "Request for Copy of Record(S) - Third-Party With the Individual Appellant's Consent"

Rate (4.7 / 5) 92 votes
Size: 1 MB
1 page

Form HHS-733 "Identity Verification"

Rate (4.3 / 5) 61 votes
Size: 1 MB
1 page

Form HHS-721 "Individual Appellant's Consent to Third-Party for Copies for the Individual Appellant's Record(S)"

Rate (4.7 / 5) 39 votes
Size: 1 MB
2 pages

Form CMS-838 "Medicare Credit Balance Report"

Rate (4.3 / 5) 15 votes
Size: 100 KB
6 pages

Form 190 "Quantitative Liver Function Test Record"

Rate (4.7 / 5) 99 votes
Size: 85 KB
4 pages

Form CMS-807 "Surveyor Notes Worksheet"

Rate (4.7 / 5) 47 votes
Size: 69 KB
2 pages

Form CMS-209 "Laboratory Personnel Report (Clia)"

Rate (4.5 / 5) 107 votes
Size: 185 KB
2 pages