Form CMS1696 Appointment of Representative - Large Print

What Is Form CMS1696?

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 August 1, 2018 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form CMS1696?
A: Form CMS1696 is the Appointment of Representative form used by the Centers for Medicare & Medicaid Services.

Q: What is the purpose of Form CMS1696?
A: Form CMS1696 is used to appoint a representative to act on behalf of a Medicare beneficiary in dealing with Medicare matters.

Q: Can I get Form CMS1696 in large print?
A: Yes, Form CMS1696 is available in large print for individuals with visual impairments.

Q: Do I need to complete Form CMS1696 in order to appoint a representative?
A: Yes, completing Form CMS1696 is necessary to officially appoint a representative for Medicare matters.

Q: Are there any specific eligibility requirements to appoint a representative using Form CMS1696?
A: No, there are no specific eligibility requirements to appoint a representative using Form CMS1696.

Q: What information is required on Form CMS1696?
A: Form CMS1696 requires information such as the beneficiary's name, Medicare number, representative's name, and contact information.

Q: Is there a deadline for submitting Form CMS1696?
A: There is no specific deadline for submitting Form CMS1696, but it is recommended to submit it as soon as possible to ensure timely processing of the appointment.

Q: What should I do if I need assistance in completing Form CMS1696?
A: If you need assistance in completing Form CMS1696, you can contact the Centers for Medicare & Medicaid Services for guidance.