CMS Fingerprint Collection and Submission Process
In accordance with the Affordable Care Act (ACA) and implementing regulations, the Centers for Medicare and Medicaid Services (CMS) must conduct a fingerprint based background check on all individuals with a 5 percent or greater ownership interest in a provider or supplier that falls under the high risk category for purposes of enrollment screening. Accurate Biometrics has been contracted by CMS as the Fingerprint Based Background Check (FBBC) Contractor.
The following instructions will guide you through the fingerprint collection and submission procedure. If, at any time during this process you have a question, please call our customer service center at 1-866-361-9944 for assistance.
STEP 1: GET FINGERPRINTED
- Print the standard fingerprint form (FD-258) and Affidavit on regular printer paper by clicking the button below:
- Fingerprints should be placed on the FD-258 fingerprint card.
- Individuals may NOT fingerprint themselves; fingerprints MUST be obtained from a law enforcement agency or fingerprint vendor.
- Each fingerprint form FD-258 must include rolled impressions of all 10 fingerprints and impressions of all 10 fingerprints taken simultaneously. (these are sometimes referred to as plain or flat impressions)
- Affidavit must be completed by the local law enforcement agency or fingerprint vendor.
- Contact your local law enforcement agency or fingerprint vendor to make arrangements to have your affidavit completed and hard copy ink fingerprints taken directly on each of these forms (photocopies of your fingerprints are not permitted; however, if the agency taking the prints uses livescan and a printer to print a fingerprint card, that method is acceptable). Please note that the agency may charge a fee to take your fingerprints.
- To search for a suggested fingerprint collection site, click the button below:
STEP 2: MAIL THE REQUIRED ITEMS - PAYMENT NOT REQUIRED
- One original, complete Fingerprint card: FD-258 (see step 1). We prefer to receive cards that are not folded.
- One original, complete Affidavit of Person Collecting Fingerprints
- Mail To:
4849 N. Milwaukee Avenue
Chicago, IL 60630