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

About this form

Please use this form to pay your public use files, limited data sets, and research identifiable files fees. 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

Accepted Payment Methods:

  • Bank account (ACH)
  • Debit or credit card

By creating an account you can:

  • See the payments you made since you created an account.
  • Store payment information, such as credit card numbers, so that you do not have to reenter it each time you make a payment.
  • Copy a form you already submitted so that you do not have to reenter you information next time.
  • Set up automatic recurring payments (from a bank account, debit card, or credit card).

To take advantage of these benefits, you can Sign In or Create an Account . To continue as a guest user, click the 'Continue to the Form' button.

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.

Need Help?

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Contact: Judy Reinecke
Email: Click to email
Phone: 410-786-9264

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