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Report a Change of Ownership/Merger Acquisition
Report a Change of Ownership/Merger Acquisition

Report a Change of Ownership/Merger Acquisition


Best Practices for Change of Ownership/Merger Acquisition

  1. Verify that you are using the correct version of the CMS-855 (07/11)
  2. Take advantage of PECOS to complete your enrollment application
  3. If not e-signing, remember to mail the signed and dated certification statements
  4. Be sure to pay the application fee or submit a hardship request
  5. Ensure that your application is complete and that all supporting documentation is included
  6. Ensure that the Legal Business Name entered in section 2 matches the name located on your IRS tax documentation
  7. Sign and date your application
  8. Respond quickly to any requests for additional information
Last Modified: 6/28/17

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Mailing Address:

National Government Services, Inc.

P.O. Box 6474 | Indianapolis, IN 46206-6474

Contact Enrollment:

855-834-5596

Available by phone Monday-Friday*
JK: 8:00 a.m.-4:00 p.m. ET
J6: 8:00 a.m.-4:00 p.m. CT
J6: 9:00 a.m.-5:00 p.m. ET

*Closed for training on the 2nd and 4th Friday of the month
12:00 p.m.-4:00 p.m. ET
11:00 a.m.-3:00 p.m. CT

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