• Before You Begin
  • Complete Agency Form
  • Enter Payment Info
  • Review & Submit
  • Confirmation

About this form

Please use this form to pay for fees related to accessing public use files, limited data sets, and research identifiable files. Also use this form to pay all other recovery of data processing fees from the Centers for Medicare & Medicaid Services. This form is NOT to be used for submitting the CMS 855 Application Fee. If you need to submit a new enrollment or revalidation fee, please use the following link:

https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do
 
Pay.gov has a daily limit on credit card transactions of $24,999 per card. There is no limit on debit transactions.
 
This form is ONLY for making payments for CMS Public Use Files, Limited Data Sets and Research Identifiable Files. This form CANNOT be used for ANY other type of payment (i.e. enrollment, revalidation or penalty fees) to CMS. Incorrect payments CANNOT be applied to other CMS accounts. All incorrect payments will be refunded and they must be paid through the correct method.


Accepted Payment Methods:

  • Bank account (ACH)
  • Debit or credit card

With an account you can:

  • See the payments you made since you created an account.
  • Store payment information so you don't have to re-enter it.
  • Copy a form you already submitted the next time you need to make a payment.

To take advantage of these benefits, you can Sign In . If you don't have an existing account, you will have the option to create an account on the sign-in page. To continue as a guest user, click the 'Continue to the Form' button.

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This is a secure service provided by United States Department of the Treasury. The information you will enter will remain private. Please review our privacy policy for more information.

Contact:
Sadie Vong
Email:
Phone:
(410) 786-0787