1. Type of request
Check only one: New, Certify (with a due date by month and year), Connect/Disconnect, Change User Information or Delete, plus the UserID in capital letters and the EUA WorkFlow Request No.
CMS-20037
APPLICATION FOR ACCESS TO CMS COMPUTER SYSTEMS
- Agency
- CMS
- Revision
- 06/10
- Fillable fields
- 169
- Pages
- 3
- Official source
- CMS form page
- Checked
- October 20, 2026
Form CMS-20037: Application for Access to CMS Computer Systems
Form CMS-20037 is the Application for Access to CMS Computer Systems from the Centers for Medicare & Medicaid Services. It handles a CMS UserID: the request types are New (issue a CMS UserID), Certify, Connect/Disconnect (add or remove access authorities), Change User Information and Delete (remove the CMS UserID from all CMS systems). The CMS page lists the form as OMB Exempt.
The user types on the form include CMS employees, Medicare Advantage and Prescription Drug Plan contract users, Medicare and other CMS contractors, researchers, Quality Improvement Organizations, End-Stage Renal Disease Networks, State agencies and other federal agencies. The form asks for user details, workload numbers, the access job codes needed and a justification, then one or two approver signatures. Page 3 carries a Privacy Act statement, the security requirements for users of CMS computer systems and the applicant's signature.
The form says approvers can sign on the form or approve online through the EUA WorkFlow request number referenced on page 1. You can fill it out free in your browser on this page and download the result without an account.
What's on Form CMS-20037
2. User information
User type, name as it should be published, company or organization, mailing address, office and company phone and email. Onsite users add their CMS region or facility, mail stop and desk location.
3. Workload information
Contract numbers, carrier numbers, contract and task number, grant number and inter-agency agreement number, whichever applies.
4. Required accesses
Connect, Disconnect or Keep for the default CMS Employee or Non-CMS Employee access and for each job code written in.
5. Justification and 6. Approvals
A justification (for a name change, the old and new name), an authorization statement, and each approver's printed name, phone, CMS UserID, signature and date.
Page 3: applicant statement
Printed name, Social Security Number, date of birth and CMS UserID, the Privacy Act statement, the security requirements and the applicant's signature and date.
How to fill out Form CMS-20037
- 1
Choose the request type
Check only one request type. For Certify, enter the due date month and year.
- 2
Fill in user information
Pick the user type and enter the name, organization, address, phone and email, plus the CMS employee and onsite details where they apply.
- 3
Add workload numbers
Enter the contract, carrier, task, grant or inter-agency agreement number that matches the user type.
- 4
List the accesses
Mark Connect, Disconnect or Keep for each access. The form points to a CMS web page for the list of available job codes.
- 5
Justify and get approvals
Write the justification, then have the approvers sign page 2 or approve online through the EUA WorkFlow request.
- 6
Read and sign page 3
The form says the applicant reads, completes and signs page 3, which holds the Privacy Act statement and the security requirements.
Why fill Form CMS-20037 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the CMS, not a copy someone retyped
- Works on a phone, tablet or computer
Approval, privacy and security notes
Where it goes
The form does not print a mailing address. Approvals are given by signature on page 2 or online through the EUA WorkFlow request number referenced on page 1.
Social Security Number
The Privacy Act statement says furnishing the information, including the Social Security Number, is voluntary, but without it access to CMS computer systems will not be granted.
Changes after approval
The authorization statement says any change in employment status or access needs is to be reported immediately, by this form or an EUA WorkFlow request.
Security requirements
Page 3 lists rules for users, such as not lending an identification number or password, which the form says serve as an electronic signature, and not using CMS data files for unauthorized purposes.
Reporting a problem
The form says a suspected violation, or a password that may have been used by someone else, is reported to the component's Information Systems Security Officer.
Related forms
CMS-10175
Electronic File Interchange Organization (EFIO) Certification Statement
8 fields, 3 pages
CMS-20040
Regional Office Meeting/Speaker Request Form
50 fields, 2 pages
CMS-632FOI
FREEDOM OF INFORMATION ACT REQUEST
73 fields, 2 pages
CMS-R-0235L
Data Use Agreement (DUA)- Limited Data Sets
50 fields, 6 pages
Who uses Form CMS-20037?
Section 2 lists the user types, and Section 6 names the approvers.
Official sources and the blank
Do it all with indox
No tool matches that search.
Questions about Form CMS-20037
What is Form CMS-20037 used for?
It is the Application for Access to CMS Computer Systems. Its request types issue a new CMS UserID, certify one, add or remove access authorities, change user information or delete the UserID from all CMS systems.
Who approves a CMS-20037 request?
A 1st approver, such as a CMS Project Officer, CMS contact, CMS supervisor or MCIC contact. The form says a 2nd approver is not required for CMS employees, BHRC or Commissioned Corps.
Can the approvals be done online?
The form says approvers can provide signatures on page 2 or approve online through the EUA WorkFlow request number referenced on page 1.
Is a Social Security Number required?
The Privacy Act statement says furnishing the information, including the Social Security Number, is voluntary. It also says access to CMS computer systems will not be granted without it.
What if my access needs change later?
The authorization statement says changes in employment status or access needs are to be reported immediately by submitting this form or an EUA WorkFlow request.
What happens if the security requirements are violated?
The form says a violation could result in termination of systems access privileges and disciplinary or adverse action, depending on how serious it is, and that laws may provide criminal penalties for illegal access.