Form CMS-1696 Appointment of Representative

What Is Form CMS-1696?

This is a legal form that was released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services on September 1, 2021 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

• Released on September 1, 2021;
• The latest available edition released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services;
• Easy to use and ready to print;
• Yours to fill out and keep for your records;
• Compatible with most PDF-viewing applications;
• Fill out the form in our online filing application.

Download a fillable version of Form CMS-1696 by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services.