CMS-1763, request to terminate Medicare Part A or Part B
Download CMS-1763 and follow Social Security's required interview or appointment process before submitting the signed termination request.
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Check the official form requirements
Download the current CMS-1763, then complete and sign it outside IRIS. Use IRIS for the finished PDF only when the agency's required filing method and the acceptable-use policy permit a printed PDF.
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Read the current Centers for Medicare & Medicaid Services instructionsLoading the document tools…