Accelerated/Advance Payment Request Form

Note: As of April 26, 2020, CMS is no longer accepting any new applications for the Advance Payment Program (Part B providers). As of October 8, 2020, CMS will no longer accept applications for the Accelerated and Advance Payments Program as they relate to the COVID-19 Public Health Emergency.

The Accelerated/Advance Payment Request form has been updated to reflect only information needed related to COVID-19 relief requests.

Note: It is not necessary to resubmit previous requests using this new form. Use the new form only for new requests for COVID-19 relief.

The forms are located at: