Description: Please use this form ONLY to submit your 2016 benefit year annual enrollment count and remit the contribution amount owed for the ACA Transitional Reinsurance Program. ACH Company ID - 7505008016 and Company Name - USDEPTHHSCMS. Please email reinsurancecontributions@cms.hhs.gov if you need to submit your Previous Year's ACA Transitional Reinsurance Program Annual Enrollment Contributions form and contributions.

Description: Please use this form ONLY to submit your 2014 benefit year annual enrollment count and remit the contribution amount owed for the ACA Transitional Reinsurance Program.... ACH Company ID - 7505008015 and Company Name - USDEPTHHSCMS. Please use the Current Year ACA Transitional Reinsurance Program Annual Enrollment Contributions form to submit your Current Year contributions.

Description: Please use this form ONLY to submit your 2015 benefit year annual enrollment count and remit the contribution amount owed for the ACA Transitional Reinsurance Program. ACH Company ID - 7505008015 and Company Name - USDEPTHHSCMS. Please email reinsurancecontributions@cms.hhs.gov if you need to submit your Previous Year's ACA Transitional Reinsurance Program Annual Enrollment Contributions form and contributions.

Description: Use this form to pay your CLIA fees.

Description: Please use this form to pay for CMS FOIA requests.

Description: Please use this form to pay amounts owed related to the Health Insurance Marketplace and Premium Stabilization Programs. Additionally, if necessary, provide the following information to your bank to prevent debit blocking on the payments processed through Pay.gov on your dunning letter/invoice: ACH Company Name: USDEPTHHSCMS...Agency Company ID: 7505008014

Description: Use this form to pay your IDR invoice.

Description: Use this form to pay Long-term care, COVID-19, HHA or CLIA Civil Money Penalty.

Description: Please use this form to pay your Medicare Coverage Gap Discount Program Civil Monetary Penalties