Get Computer Access Form

Filling out the Computer Access Form online is an essential process for users needing access to the Centers for Medicare & Medicaid Services' systems. This guide provides a clear and comprehensive step-by-step approach to completing the form correctly and efficiently.

Follow the steps to successfully complete the Computer Access Form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by selecting the type of request in Section 1. You can choose among options such as issuing a CMS UserID, connecting or disconnecting access, changing user information, or deleting a UserID. Ensure you check only one option.
3. In Section 2, fill out your user information accurately. Provide your first name, middle initial, and last name as you would like them published. Select your organization and complete the mailing address, including city, state, zip code, and email address.
4. Complete Section 3 by providing related workload information, including contract numbers and grant numbers where applicable. Ensure this information reflects your current responsibilities.
5. In Section 4, specify the required accesses for your role. This may include options for connecting or disconnecting various systems. Review the job codes available on the CMS website to ensure you are selecting correctly.
6. Section 5 requires you to provide justification for the access needed. Be clear and specific to support your request.
7. In Section 6, gather signatures from the required approvers, verifying that your organization is responsible for your resource use and that all information provided is accurate.
8. Finally, read and sign the applicant section, reviewing the Privacy Act Statement and security requirements. Ensure all sections are complete before proceeding.
9. Once you have filled out all necessary information, you can save changes, download, print, or share the form as needed to finalize your submission.

Complete the Computer Access Form online to ensure timely access to necessary systems.