About this form

Use this Form to apply for Enrollment and pay your Application Fee.

• You may submit up to 5 Schedule As on Pay.gov.    
• Complete all fields of the Schedule A, except item 6.     
• Provide your response to item 6 in a PDF file (not exceeding 10 MB).  If you are submitting several Schedule As, include all responses to item 6 in the same PDF file.  Label each response.     
• You will upload your PDF file after submitting your form and before making your payment.   

Remember to keep a copy of your completed form.  If you are signed in when you submit your form and payment, you can view or print your form later.  If you aren't signed in or don't have a Pay.gov account, you should print your form at the PDF Preview button before proceeding to the payment submission page; you will not be able to print your form later.   

Accepted Payment Methods:

• Bank account (ACH)
• Debit or credit card