Submit Enrollment Application

For First Time Users: Request a User ID and Connection

Instructions for accessing PECOS:

  • If you are unsure if you have a user ID, select “Forgot User ID?” from PECOS.
  • If you do not have a user ID and password, become a registered user by selecting “Register for a user account” from PECOS.
  • If you already have or after you create a user ID and password and need to establish a connection to an enrollment record (employer), select “Manage/Update User Profile” from PECOS.
  • If you have any questions during this registration/connection process, you may call the EUS help desk for assistance at 866-484-8049   
  • Once you have a user ID and password, established a connection to the enrollment record (individual, organization), you may proceed to create and submit an initial, change or revalidation application in PECOS.

Related Content

Reviewed 7/30/2024

Helpful Resources

Check Provider Enrollment Application Status
Log Into PECOS
Pay Application Fee

J6 Mailing Address:

National Government Services, Inc.
P.O. Box 6475
Indianapolis, IN 46206-6475

Interactive Voice Response:

877-908-9499

Contact Enrollment:

877-908-8476

Hours Available:

Monday–Friday
8:00 a.m.–4:00 p.m. CT

Form(s) you'll need:

Enrollment Forms

Helpful Resources

Check Provider Enrollment Application Status
Log Into PECOS
Pay Application Fee

JK Mailing Address:

National Government Services, Inc.
P.O. Box 7149
Indianapolis, IN 46207-7149

Interactive Voice Response:

877-869-6504

Contact Enrollment:

888-379-3807

Hours Available:

Monday–Friday
8:00 a.m.–4:00 p.m. ET

Form(s) you'll need:

Enrollment Forms