BASIS OF

ITEM NO. DESCRIPTION AWARD UNIT RATE COST UNIT RATE COST UNIT RAT

I. Pre‐Press and Data Processing:

(a) Data Processing (inclds Electonic Pre‐Press and Reporting (other than IMb and SD

operations), all Mailing Kits and Versions), per 1,000 records 25,685 $7.50 $192,637.50 $0.25 $6,421.25 $0.1

(b) Create Scan Line for CMS‐500 and CMS‐500ID, Versions A and B, per 1,000 records 15,961 NC $0.00 $0.25 $3,990.25 $0.1

(c) Domestic Mail Prep (inclds all IMb and SD operations), all Mailing Kits and

Versions, per 1,000 addresses 25,647 $2.50 $64,117.50 $0.25 $6,411.75 $0.1

(d) International Mail Preparation, all Mailing Kits and Versions, per 1,000 addresses 38 $100.00 $3,800.00 $10.00 $380.00 $0.1

II. Proofs and Prior‐to‐Produciton Samples:

(a) CMS Forms Templates (no variable data), Versions A and B, each proof 8 $100.00 $800.00 NC $0.00 $50.0

(b) CMS Forms Templates (no variable data), Versions C and D, each proof 8 $100.00 $800.00 NC $0.00 $50.0(c) Bill Stuffers, 8‐1/2 x 14" trim size with 2 inks, Versions A and B, each proof 24 $100.00 $2,400.00 NC $0.00 $50.0

(d) Bill Stuffers, 8‐1/2 x 11" trim size with single ink, Versions A and B, each proof 11 $100.00 $1,100.00 NC $0.00 $50.0(e) Bill Stuffers, 8‐1/2 x 11" trim size with single ink, Versions C and D, each proof 46 $100.00 $4,600.00 NC $0.00 $50.0(f) Envelopes:

(1) Mailing Envelopes, 4‐1/8 x 9‐1/2" trim size, each proof 4 $100.00 $400.00 NC $0.00 $50.0

(2) Mailing Envelopes, 9 x 12" trim size, each proof 1 $100.00 $100.00 NC $0.00 $50.0(3) Reply Envelopes, 3‐7/8 x 8‐7/8" trim size, each proof 2 $100.00 $200.00 NC $0.00 $50.0

(g) Prior‐to‐Production Samples:

(1) Mailing Kits 1 and 2 (CMS‐500 and CMS‐500ID), Versions A and B, each set 4 $500.00 $2,000.00 NC $0.00 $50.0

(2) Mailing Kits 1 and 2 (CMS‐500 and CMS‐500ID), Versions C and D, each set 4 $500.00 $2,000.00 NC $0.00 $50.0

(3) Mailing Kits 3 and 4 (CMS‐20143 and CMS‐20143ID), Versions A and B, each set 4 $500.00 $2,000.00 NC $0.00 $50.0

(4) Mailing Kits 3 and 4 (CMS‐20143 and CMS‐20143ID), Versions C and D, each set 4 $500.00 $2,000.00 NC $0.00 $50.0

II. Printing/Imaging, Cutting to Size, and Construction:

1. Version A, Standard Print English and Version B, Standard Print Spanish:

(a) CMS‐500 and CMS‐500ID (inclds prntg Scan Line, perf'ing, & folding forms), each form

(1) Makeready and/or Setup Charges 48 NC $0.00 $25.00 $1,200.00 $100.0

(2) Running Charges, per 1,000 Copies 15,961 $27.44 $437,969.84 $17.50 $279,317.50 $6.9

(b) CMS‐20143 and CMS‐20143ID (inclds folding), each form

(1) Makeready and/or Setup Charges 48 NC $0.00 $25.00 $1,200.00 $100.0

(2) Running Charges, per 1,000 Copies 9,720 $17.15 $166,698.00 $17.50 $170,100.00 $6.9

(c) 8‐1/2 x 11" Single Ink Bills Stuffers (includes folding stuffers), each stuffer

(1) Makeready and/or Setup Charges 11 NC $0.00 $25.00 $275.00 $100.0

(2) Running Charges, per 1,000 Copies 7,218 $17.15 $123,788.70 $18.00 $129,924.00 $7.7

(d) 8‐1/2 x 14" Two Ink Bills Stuffers (includes folding stuffers), each stuffer

(1) Makeready and/or Setup Charges 24 NC $0.00 $25.00 $600.00 $100.0

(2) Running Charges, per 1,000 Copies 2,050 $44.00 $90,200.00 $28.02 $57,441.00 $20.3

Title: Medicare Premium Bill Mailing Kits

Term: Date of Award through January 31, 2025 plus up to 4 option year periods

Advantage Mailing 

040‐02494 

C

Miamisburg, OH/Greenville, SC

Amsive

Anaheim, CA

340‐81281

Program 3561‐S
BASIS OF

ITEM NO. DESCRIPTION AWARD UNIT RATE COST UNIT RATE COST UNIT RAT

Title: Medicare Premium Bill Mailing Kits

Term: Date of Award through January 31, 2025 plus up to 4 option year periods

Advantage Mailing 

040‐02494 

C

Miamisburg, OH/Greenville, SC

Amsive

Anaheim, CA

340‐81281

Program 3561‐S

2. Version C, Large Print English and Version D, Large Print Spanish:

(a) CMS Forms, each form

(1) Makeready and/or Setup Charges 96 $100.00 $9,600.00 $25.00 $2,400.00 $100.0

(2) Running Charges, per 1,000 Copies 4 $1,000.00 $4,000.00 $100.00 $400.00 $234.1

(b) Bill Stuffers, 6 pages, each stuffer

(1) Makeready and/or Setup Charges 22 $100.00 $2,200.00 $25.00 $550.00 $100.0

(2) Running Charges, per 1,000 Copies 1 $1,000.00 $1,000.00 $500.00 $500.00 $171.9

(c) Bill Stuffers, 10 pages, each stuffer

(1) Makeready and/or Setup Charges 24 $100.00 $2,400.00 $25.00 $600.00 $100.0

(2) Running Charges, per 1,000 Copies 1 $1,000.00 $1,000.00 $600.00 $600.00 $280.0

3. Envelopes (includes construction):

(a) Mailing Envelopes, 4‐1/8 x 9‐1/2" trim size, each envelope

(1) Makeready and/or Setup Charges 12 NC $0.00 NC $0.00 $50.0

(2) Running Charges, per 1,000 Copies 25,685 $15.00 $385,275.00 $13.38 $343,665.30 $8.7

(b) Mailing Envelopes, 9 x 12" trim size, each envelope

(1) Makeready and/or Setup Charges 12 NC $0.00 NC $0.00 $50.0

(2) Running Charges, per 1,000 Copies 4 $100.00 $400.00 $500.00 $2,000.00 $293.5

(c) Reply Envelopes, 3‐7/8 x 8‐7/8" trim size, each envelope

(1) Makeready and/or Setup Charges 12 NC $0.00 NC $0.00 $50.0

(2) Running Charges, per 1,000 Copies 15,963 $15.00 $239,445.00 $11.37 $181,499.31 $6.8

IV. Paper:

(a) White Uncoated Text, 50 lbs., equal to JCP Code A60:

(1) 8‐1/2 x 11" Trim Size, per 1,000 Leaves 32,923 $8.99 $295,977.77 $9.18 $302,233.14 $5.8

(2) 8‐1/2 x 14" Trim Size, per 1,000 Leaves 2,050 $11.44 $23,452.00 $11.16 $22,878.00 $11.4

(b) White Writing/Wove Envelope, 20 or 24 lbs., equal to JCP Code V20:

(1) 3‐7/8 x 8‐7/8" Trim Size, per 1,000 Leaves 15,963 $15.00 $239,445.00 $11.37 $181,499.31 $6.8

(2) 4‐1/8 x 9‐1/2" Trim Size, per 1,000 Leaves 25,685 $15.00 $385,275.00 $13.38 $343,665.30 $8.7

(3) 9 x 12" Trim Size, per 1,000 Leaves 4 $100.00 $400.00 $462.00 $1,848.00 $293.5

V. Gathering, Inserting, and Preparing for Mailing:

(a) All Mailing Kits, Versions A and B Only, with or without Reply Envelopes, with or

without Bill Stuffers, per 1,000 mailers 25,681 $22.50 $577,822.50 $15.00 $385,215.00 $23.9

(b) All Mailing Kits, Versions C and D Only, with or without Reply Envelopes, with or

without Bill Stuffers, per 1,000 mailers 4 $1,000.00 $4,000.00 $827.00 $3,308.00 $296.8

$3,269,303.81 $2,430,122.11 

0.25% $8,173.26 0.00% $0.00 0.25

20 Days $3,261,130.55 NET $2,430,122.11 20 Da

Created by: LLP 12/19/2023

Verified by: TN 12/20/2023

Awarded to: NPC, Claysburg, PA

AWARD

CONTRACTORS TOTALS

DISCOUNT

DISCOUNTED TOTALS
Program 3561-S Page 1 of 92

Written by LLP

Reviewed by MJS

US Government Publishing Office

Northeast Region

General Terms, Conditions, and Specifications

for the Procurement of

Medicare Premium Bill Mailing Kits

as requisitioned from the U.S. Government Publishing Office (GPO) by

the Department of Health and Human Services, Centers for Medicare & Medicaid Services

Single Award

TERM OF CONTRACT 

The term of this contract includes an initial testing period and a production period.

INITIAL TESTING PERIOD 

Beginning Date of Award through January 31, 2024. 

PRODUCTION PERIOD 

Beginning February 1, 2024 through January 31, 2025, plus up to four optional 12-month extension period(s) 

(February 1, 2025 through January 31, 2026, February 1 2026 through January 31, 2027, February 1, 2027 

through January 31, 2028, and February 1, 2028 through January 31, 2029). Special attention is directed to the 

“Economic Price Adjustment” clause in Section 1 of this contract.

BID OPENING 

Bids shall be opened at 11:00 a.m., prevailing Columbus, Ohio time, on December 19, 2023. 

BID SUBMISSION 

Bidders MUST submit e-mail bids to bidsnortheast@gpo.gov for this solicitation. No other method of bid 

submission will be accepted at this time.

The company name, program number, and bid opening date must be specified in the subject line of the e-mailed 

bid submission. Bids received after 11:00 a.m. prevailing Columbus, Ohio time on the bid opening date specified 

above will not be considered for award.

NOTICE TO BIDDERS 

Formerly Program 261-S. Bidders are cautioned to familiarize themselves with all provisions of this contract 

before bidding. Significant revisions have been made throughout the contract.

Special attention is directed to the bid submission provisions under “Additional E-mailed Bid Submission 

Provisions” on page 13. 

Abstract of bids for Program 261-S available at https://www.gpo.gov/how-to-work-with-us/vendors/contract-pricing. 

For information of a technical nature call Linda Price at (614) 488-4616, ext. 7 (no collect calls) or e-mail to 

lprice@gpo.gov. 
Medicare Premium Bill Mailing Kits Page 2 of 92

3561-S (01/25)

SECTION 1 – GENERAL TERMS AND CONDITIONS 

GPO CONTRACT TERMS 

Any contract which results from this Invitation for Bid will be subject to the applicable provisions, clauses, and 

supplemental specifications of GPO Contract Terms (GPO Pub. 310.2, effective December 1, 1987 (Rev. 1-18)) and GPO 

Contract Terms, Quality Assurance Through Attributes Program for Printing and Binding (GPO Pub. 310.1, effective May 

1979 (Rev. 09-19)). 

GPO Contract Terms (GPO Publication 310.2): https://www.gpo.gov/docs/default-source/forms-and-standards-files-forvendors/contractterms2018.pdf

GPO QATAP (GPO Publication 310.1): https://www.gpo.gov/docs/default-source/forms-and-standards-files-forvendors/qatap-rev-09-19.pdf. 

More GPO Publications can be found at: https://www.gpo.gov/how-to-work-with-us/vendors/forms-and-standards

REGULATIONS GOVERNING PROCUREMENT 

The U.S. Government Publishing Office (GPO) is an office in the legislative branch of the United States Government. 

Accordingly, the Federal Acquisition Regulation is inapplicable to this, and all GPO procurements. However, the text of 

certain provisions of the Federal Acquisition Regulation as contained in the Code of Federal Regulations (CFR), are 

referenced in this solicitation. The offeror should note that only those provisions of the Federal Acquisition Regulation 

which are specifically incorporated by reference into this solicitation are applicable.

SUBCONTRACTING 

The predominant production functions are downloading files, manipulating data from TIBCO MFT or the Gentran 

(backup mailbox), printing of computerized variable imaging, and mailing. These functions CANNOT be subcontracted. 

All other items, including printing of static data without PII/PHI and envelope manufacturing and printing are not 

considered part of the predominant production functions. Bidders who must subcontract any of the predominant 

production functions will be declared non-responsible.

SECURITY 

The contractor awarded this contract will be in custody of Government owned material considered Personally Identifiable 

Information (PII). See “Section 5. – CMS Security Specifications” for security requirements of this contract. The 

Government may conduct on-site unannounced, randomized Security inspections at any time.

CMS Acceptable Risk Safeguards for TIBCO transmissions: Low Security Impact Level.

PRIVACY ACT NOTIFICATION 

This procurement action requires the contractor to do one or more of the following: design, develop, or operate a system 

of records on individuals to accomplish an agency function in accordance with the Privacy Act of 1974, Public Law 

93-579, December 31, 1974 (5 U.S.C. 552a) and applicable agency regulations. Violation of the Act may involve the 

imposition of criminal penalties as stated in 5 U.S.C. 552a (i) (1) CRIMINAL PENALTIES. It is incumbent upon the 

contractor to inform its officers and employees of the penalties for improper disclosure imposed by the Privacy Act of 

1974, 5 U.S.C. 552a, specifically, 5 U.S.C. 552a (i) (1) CRIMINAL PENALTIES and m (1) GOVERNMENT 

CONTRACTORS.
Medicare Premium Bill Mailing Kits Page 3 of 92

3561-S (01/25)

PRIVACY ACT

(a) The contractor agrees:

 (1) to comply with the Privacy Act of l974 and the rules and regulations issued pursuant to the Act in the design, 

development, or operation of any system of records on individuals in order to accomplish an agency function 

when the contract specifically identifies (i) the system or systems of records and (ii) the work to be performed 

by the contractor in terms of any one or combination of the following: (A) design, (B) development, or (C) 

operation;

 (2) to include the solicitation notification contained in this contract in every solicitation and resulting subcontract 

and in every subcontract awarded without a solicitation when the statement of work in the proposed 

subcontract requires the design, development, or operation of a system of records on individuals to 

accomplish an agency function; and

 (3) to include this clause, including this paragraph (3), in all subcontracts awarded pursuant to this contract which 

require the design, development, or operation of such a system of records.

 (b) In the event of violations of the Act, a civil action may be brought against the agency involved where the violation 

concerns the design, development, or operation of a system of records on individuals to accomplish an agency 

function, and criminal penalties may be imposed upon the officers or employees of the agency where the violation 

concerns the operation of a system of records on individuals to accomplish an agency function. For purposes of 

the Act when the contract is for the operation of a system of records on individuals to accomplish an agency 

function, the contractor and any employee of the contractor is considered to be an employee of the agency.

(c) The terms used in this clause have the following meanings:

 (1) “Operation of a system of records” means performance of any of the activities associated with maintaining the 

system of records including the collection, use, and dissemination of records.

 (2) “Record” means any item, collection or grouping of information about an individual that is maintained by an 

agency, including, but not limited to, his education, financial transactions, medical history, and criminal or 

employment history and that contains his name, or the identifying number, symbol, or other identifying 

particular assigned to the individual, such as a finger or voice print or a photograph.

 (3) “System of records” on individuals means a group of any records under the control of any agency from which 

information is retrieved by the name of the individual or by some identifying number, symbol, or other 

identifying particular assigned to the individual.

SECURITY PLAN 

The contractor must have a formal, documented Security Plan that will ensure their compliance with all of the security 

provisions of this contract and as referenced in attached exhibits. Particular attention should be given to addressing 

compliance of the Federal Information Security Management Act of 2002 (FISMA) and the Privacy Act of 1974 as 

specified herein as referenced in “Section 5. – CMS Security Specifications”. 

Minimum security requirements for FISMA compliance are defined by the Department of Commerce, National Institute 

of Standards and Technology (NIST) in Federal Information Processing Standards Publication (FIPS) Publication 200 

“Minimum Security Requirements for Federal Information and Information Systems”. This document can be found on 

the Internet at http://csrc.nist.gov/publications/fips/fips200/FIPS-200-final-march.pdf. 

The contractor’s Security Plan must, at a minimum, cover 17 security-related areas identified in FIPS 200 with regard to 

protecting the confidentiality, integrity, and availability of federal information processed, stored, and transmitted by those 

systems.
Medicare Premium Bill Mailing Kits Page 4 of 92

3561-S (01/25)

The security-related standards include: (i) access control; (ii) awareness and training; (iii) audit and accountability; (iv) 

certification, accreditation, and security assessments; (v) configuration management; (vi) contingency planning; (vii) 

identification and authentication; (viii) incident response; (ix) maintenance; (x) media protection; (xi) physical and 

environmental protection; (xii) planning; (xiii) personnel security; (xiv) risk assessment; (xv) systems and services 

acquisition; (xvi) system and communications protection; and (xvii) system and information integrity. The 17 areas 

represent a broad-based, balanced information security program that address the management, operational, and technical 

aspects of protecting federal information.

Within two workdays after award, the contractor must submit three (3) copies of their Security Plan to: HHS/CMS, Attn: 

Mark Rydberg, SL-12-18, 7500 Security Blvd. Baltimore, MD 21244-1850. Release of PII by CMS does not constitute 

CMS’ approval or acceptance of the Security Plan.

At the same time the Security Plan is submitted to the Baltimore, MD address above, a copy of the plan, without PII, 

should be e-mailed to mark.rydberg@cms.hhs.gov, infonortheast@gpo.gov and lprice@gpo.gov. 

At any time during this contract, if CMS finds deficiencies in the Security Plan, CMS may require correction of the 

deficiency.

QUALITY ASSURANCE LEVELS AND STANDARDS 

The following levels and standards shall apply to these specifications:

Product Quality Levels:

(a) Printing (page related) Attributes – Level III 

 (b) Finishing (item related) Attributes – Level III

(c) Exceptions: Scan Line tolerances as specified under Exhibits B and C

Inspection Levels (from ANSI/ASQC Z1.4):

(a) Non-destructive Tests – General Inspection Level I.

 (b) Destructive Tests – Special Inspection Level S-2.

Specified Standards: The specified standards for the attributes requiring them shall be:

 Attribute Specified Standard 

 P-7. Type Quality and Uniformity Prior-to-Production Samples

Approved Proofs

Government-Furnished Electronic Files

 P-9. Solid and Screen Tint Color Match Pantone Matching System

CONTRACTOR’S QUALITY ASSURANCE SYSTEM 

The contractor must provide and maintain an effective quality assurance system that includes, at a minimum the following 

elements:

1. Perform a random quality inspection of records in the furnished files. Samples should be tested for construction, 

type, and placement of data in each field.

2. Ensure that the computerized imaging is clear and legible and that the appropriate notices are mailed to each 

address contained in the furnished files.

3. Maintenance and calibration records on all applicable production and inspection equipment.

4. Controls that assure all steps in the process generate a product that conforms to all requirements of this 

solicitation.
Medicare Premium Bill Mailing Kits Page 5 of 92

3561-S (01/25)

5. Performance utilizing a calibration system that stops production whenever an extra piece is inserted or a piece is 

left out.

If errors are found or discrepancies exist between the furnished data files and reports, e.g. print order, record layout, etc., 

the contractor must cease further production and contact Mark Rydberg at (410) 786-3038. If errors exist in the file and 

the contractor failed to identify them during his/her quality assurance inspection, no reimbursement for the cost of 

reprinting will be allowed.

QUALITY SYSTEMS 

The contractor shall initiate, prior to start-up and maintain throughout the life of this contract, Quality Systems to assure 

conformance to all requirements of this contract. The Quality Systems plan should address what actions will be initiated 

when defects are detected. The Quality Systems shall assure the quality of components from subsidiary plants. This 

element includes assuring that components from different sources will be compatible BEFORE the start of production.

The Quality Systems shall include procedures for assuring that all variable data are accurately and completely printed and 

that all addressed items are mailed. The procedures shall explicitly describe the methods to be used to assure that no 

records are missed or duplicated when an interruption of variable printing occurs (e.g. due to equipment malfunction).

Records of tests, inspections, and critical processes shall be timed stamped and maintained on file. The records must be 

available to GPO and or HHS/CMS employees upon request until the expiration of the warranty period of this contract.

UNIQUE IDENTIFICATION NUMBER 

Contractor will furnish human readable, unique identification numbers for each mail piece, which will be used to track 

each page of each individual mail piece, thereby providing 100% accountability. This enables the contractor to track each 

mail piece through completion of the project. The contractor will be required to create a test sample every 4,000 mail 

pieces. This sample must have a unique number and must be produced on each page of each mail piece. The contractor 

will generate a list from the unique identifying numbers for each sampling. As samples are pulled, the unique numbers 

will be marked off the list.

RECOVERY SYSTEM 

A recovery system will be required to ensure that all defective, missing, or mutilated pieces detected are identified, 

reprinted, and replaced. The contractor’s recovery system must use the unique alpha/numeric identifiers assigned to each 

piece (including quality control samples) to aid in the recovery and replacement of any defective, missing, or mutilated 

pieces, and must be capable of tracking and/or locating any individual piece of mail from the time it is downloaded from 

TIBCO/GENTRAN, up to and including when it is off-loaded at the U.S. Postal Service (USPS) facility. An explanation 

of the contractor’s sequential numbering system is required to understand the audit trail required for each and every piece.

VERIFICATION OF PRODUCTION AND MAILING 

Contractor must have a tracking process (defined below) providing 100% accountability of production and mailing to 

determine that the data from the original print file is in the correct envelope with the correct number of pages. Mail pieces

requiring print regeneration must be reprinted from their original print image with the original job ID and piece ID 

remaining unchanged as each mail piece continues through the inserting life cycle. This process will repeat itself (since 

subsequent reprint runs may yield damages) until all mail pieces from the original print run have been inserted and 

accounted for.

TRACKING PROCESS 

A method for generating a plurality of mail pieces including error detection and reprinting capabilities. The method 

provides a mail handling process which tracks processing errors with the use of a first and second scan code which obtain 

information regarding each mail piece, diverts mail pieces in response to error detection, transmits such errors to a 

processor, and automatically generates a reconfigured print file to initiate reprints for the diverted mail pieces.

 
Medicare Premium Bill Mailing Kits Page 6 of 92

3561-S (01/25)

TRACKING REPORTS 

An Audit Report (see (g) under “Automated System”) and a Summary Report (see (h) under “Automated System”) shall 

be provided by the contractor as described below. Contractor must have all hardware, programming, and finalized reports 

in place to meet this requirement by the date of award and the start of live production.

Contractor must submit a sample of their proposed Audit and Summary Reports with the required Production Plans prior 

to award for approval. The Government considers grounds for the immediate default of this contract if the contractor, at 

any time, is unable to perform or found not complying with any part of this requirement.

Notice integrity shall be defined as follows:

• Each mail piece shall include all pages (and only those pages) intended for the designated recipient as contained 

in the print files received from CMS.

• The contractor’s printing process must have automated systems which can detect all sync errors, stop printing 

when detected, and identify, remove, and reprint all effected mail pieces.

Mailing integrity shall be defined as follows:

• All mail pieces received from CMS for each file date were printed, inserted, and entered correctly into the United 

States postal system.

• The contractor is responsible for providing the automated inserted mail piece tracking/reporting systems and 

processes required to validate that 100% of all mail pieces received from CMS were printed, all pages for each 

mail piece with the correct inserts are accounted for, inserted, and mailed correctly.

AUTOMATED SYSTEM 

The contractor’s inserting equipment must have automated systems that include mail piece coding and scanning 

technology capable of uniquely identifying each mail piece and corresponding leaves within each individual file by mailer 

number and file date.

(a) Entrance Scanning: A camera system must electronically track and scan all leaves of each mail piece as the 

inserting equipment pulls them into the machine to ensure each mail piece was produced and inserted. If there is 

any variance on a mail piece or if a mail piece is not verified that all leaves are present, that piece and the piece 

prior to and immediately following must be diverted and sent back for reprint. All instances of variance must be 

logged.

(b) Touch and Toss: All spoilage, diverted, mutilated, or mail pieces that are acted upon directly by a human hand 

prior to sealing must be immediately recorded, discarded, properly destroyed, and automatically regenerated in a 

new print file for reprint. Exception: Intentionally diverted pieces due to a requirement for a product, which 

cannot be intelligently inserted and requires manual insertion such as a publication, can be sealed, re-scanned and 

placed back into production. These must be programmed diverts and sent to a separate bin for processing to 

ensure they are not mixed with other problem diverts and logged into the Audit system as such.

(c) Exit Scanning: A camera system must be mounted just aft of the inserting equipment. This camera system must 

read a unique code through the window of each mail piece and capable of identifying and reporting all missing 

mail pieces that were lost or spoiled during production for each individual file by mailer number and file date. 

This system ensures that no missing mail pieces have been inadvertently inserted into another mail piece. The 

equipment must check the mail pieces, after insertion and verification that all leaves are accounted for, and divert 

any suspect product. During exit scanning, if a sequence number is missing, the mail piece prior to and 

immediately after must be diverted. The equipment must divert all mail pieces that exhibit missing or out of order 

sequence numbers and any other processing errors. All diverted pieces are to be automatically recorded and 

regenerated in a new print file for reprint.
Medicare Premium Bill Mailing Kits Page 7 of 92

3561-S (01/25)

(d) Reconciliation: All mail pieces and the amount of correct finished product must be electronically accounted for 

after insertion through the use of the audit system that is independent of the inserting equipment as well as 

independent of the operator. The sequence numbers, for each file, must be reconciled; taking into account any 

spoilage, duplicate, and/or diverted product. If the reconciliation yields divergent results, corrective action must 

be taken to locate the mail pieces that are causing any difference between the input and outputs of the inserting 

process. Therefore, all finished mail for that sequence run must be held in an accessible area until this 

reconciliation is complete.

(e) Generate a new production file for all missing, diverted, or mutilated mail pieces (reprint file).

(f) Contractor must generate an automated audit report from the information gathered from scanning for each mailer 

number, file date, and for each mail piece (manual inputs are not allowed). This audit report will contain detailed 

information for each notice as outlined above for each individual file by mailer number and file date. Contractor 

is required to provide any requested Summary and/or Audit reports within an hour of a request via e-mail in an 

MS Word, MS Excel, CSV, or PDF file.

(g) Audit report must contain the following information:

1. Job name.

2. Mailer number, file date, and mail date(s).

3. Machine ID.

4. Date of production with start and end time for each phase of the run (i.e., machine ID).

5. Start and end sequence numbers in each run.

6. Status of all sequence numbers in a run.

7. Total volume in run.

8. Status report for all incidents for each sequence number and cause (e.g., inserted, diverted, and reason for 

divert such as missing sequence number, missing leaves, mutilated, duplicate, pulled for inspection).

9. Bottom of audit report must contain total number of records for that run, quantity sent to reprint, number 

of duplicates, duplicates verified and pulled, and total completed.

10. Audit report must contain the same information for all the reprints married with this report as listed above 

showing that all pieces for each mailer number and file date are accounted for.

(h) Summary Report: Contractor must generate a final automated 100% accountability summary report for each 

individual file by mailer number and file date. This information must be generated directly from the audit report 

(manual inputs are not allowed). The summary report must contain the following:

1. Job name.

2. Each individual file by mailer number and file date (must show sequence numbers for each section, i.e., 

first pass and then reprints).

3. Sequence number range for each individual file by mailer number and file date.

4. Volume of all sequence numbers associated with an individual file by mailer number and file date that 

notices were inserted.

5. Volume of reprints that were inserted for each file date.

6. Volumes for each file date and date that each was completed.

Contractor must generate an automated audit report when necessary, showing the tracking of all mail pieces throughout all 

phases of production for each mail piece. This audit report will contain all information as outlined in items (f) and (g) 

above.

All audit, summary, and recipient-level report data must be retained in electronic form for 210 calendar days after mailing 

and must be made available to CMS for auditing of contractor performance upon request.

NOTE: The Government will not as a routine matter request that the contractor produce individual pieces in transit within 

the plant, however, the contractor must demonstrate that they have an audit trail established that has the ability to comply 

with this type request when and if the need arises. The contractor’s Quality Assurance System and the Verification of 

Production and Mailing must account for the number of pieces mailed.
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The contractor shall monitor all aspects of the job including material handling and mail flow, to assure that the production 

and delivery of these mail pieces meet specifications and Government requirements.

QUALITY CONTROL SAMPLE 

The plans must provide a description of how the contractor will create quality control samples for periodic samplings to 

be taken during the production run and shall contain control systems that will detect defective, missing, or mutilated 

pieces.

PRODUCTION PLANS 

The contractor shall present, in writing, to the Contracting Officer within two (2) workdays of being notified to do so by 

the Contracting Officer or his/her representative, detailed plans for each of the following activities. The workday after 

notification to submit will be the first day of the schedule. These proposed plans are subject to review and approval by the 

government and award will not be made prior to approval of same.

NOTE: The Government reserves the right to waive some or all of the following plans.

SECURITY PLAN 

See “Security” clause on pages 2 through 4. 

BACKUP FACILITY PLAN 

The contractor must have two or more facilities that have the capability to perform all requirements of the contract. This 

clause is to allow for continuous production with backup facilities if for any reason(s) (act of God, labor disagreements, 

etc.) The initial production facility is unable to meet all the requirements of the contract.

The backup facilities, equipment, and personnel that have completed the required security documents must be available to 

the Contracting Officer as part of the pre-award survey.

Failure to have a backup facility will result in a non-responsible determination.

MATERIAL HANDLING AND INVENTORY CONTROL PLAN 

This plan should explain in detail how the following materials will be handled: incoming raw materials; work-in-progress 

materials; quality control inspection materials; USPS inspection materials; and all outgoing materials cleared for USPS 

pickup/delivery.

QUALITY CONTROL PLAN 

The contractor shall provide and maintain, within their own organization, an independent quality assurance organization 

of sufficient size and expertise to monitor the operations performed and inspect the products of each operation to a degree 

and extent that will ensure the Government’s quality assurance, inspection, and acceptance provisions specified herein are 

met. The contractor shall perform, or have performed, the process controls, inspections, and tests required to substantiate 

that the products provided under this contract conform to the specifications and contract requirements. The contractor 

shall describe in detail their quality control/quality assurance and recovery plans describing how, when, and by whom the 

plans will be performed.

The quality control plan must also include examples and a detailed description of all quality control samples and their 

corresponding inspection reports or logs the contractor will keep in order to document the quality control inspections 

performed on each run. Furthermore, the plan must include the names of all quality assurance officials and describe their 

duties in relationship to the quality control plan.

NOTE: The quality control plan must account for the number of pieces mailed daily.

 
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QUALITY CONTROL SAMPLE PLAN 

The plan must provide a description of how the contractor will create quality control samples for periodic samplings to be 

taken during the production run, provide for backup and re-running in the event of an unsatisfactory sample, and contain 

control systems that will detect defective, missing, or mutilated pieces.

The plan should include the sampling interval the contractor intends to utilize. The contractor will be required to create 

two (2) quality control samples to be drawn from the production stream at the same time: 

• One (1) sample will be drawn, inspected, and retained as part of the contractor’s quality assurance records.

• One (1) sample will be drawn for CMS and will be packed with the remaining samples associated with each print 

order and shipped to the CMS (address to be supplied at the post-award meeting).

The plan shall detail the actions to be taken by the contractor when defective, missing, or mutilated items are discovered. 

These actions must be consistent with the requirements found in GPO Contract Terms (GPO Publication 310.2, effective 

December 1, 1987 (Rev. 1-18)). 

The plan shall monitor all aspects of the job including material handling and mail flow, to assure that the production and 

delivery of these notices meet specifications and Government requirements. This includes maintaining 100% 

accountability in the accuracy of imaging and mailing of all pieces throughout each run. The contractor must ensure that 

there are no missing or duplicate pieces.

The contractor must maintain quality control samples, inspection reports, and records for a period of no less than 120 

calendar days subsequent to the date of the check tendered for final payment by the Government Publishing Office. The 

Government will periodically verify that the contractor is complying with the approved quality control plan through onsite examinations and/or requesting copies of the contractor’s quality assurance records and quality assurance random 

copies.

MAIL PLAN 

This plan should include sufficient detail as to how the contractor will comply with all applicable U.S. Postal Service 

(USPS) mailing requirements as listed in the USPS Domestic and International Mail Manuals in effect at the time of the 

mailing and other USPS instructional material such as the Postal Bulletin. The contractor must also disclose how they 

will achieve multi-level USPS automated presort postal discounts as outlined in the contract.

WARRANTY 

Contract Clause 15, “Warranty”, of GPO Contract Terms (GPO Publication 310.2, effective December 1, 1987 (Rev. 01-

18)) is amended for the solicitation to the effect that the warranty period is EXTENDED from 120 days to one calendar 

year from the date the check is tendered as final payment. All other provisions remain the same.

OPTION TO EXTEND THE TERM OF CONTRACT 

The Government has the option to extend the term of this contract for a period of 12 months by written notice to the 

contractor not later than 30 days before the contract expires. If the Government exercises this option, the extended 

contract shall be considered to include this clause, except, the total duration of the contract may not exceed five (5) years

(January 31, 2029) as a result of, and including, any extension(s) added under this clause. Further extension may be 

negotiated under the “Extension of Term of Contract” clause. See also “Economic Price Adjustment” for authorized 

pricing adjustment(s). 

EXTENSION OF TERM OF CONTRACT 

At the request of the Government, the term of any contract resulting from this solicitation may be extended for such 

period of time as may be mutually agreeable to the GPO and the contractor.

 
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ECONOMIC PRICE ADJUSTMENT 

The pricing under this contract shall be adjusted in accordance with this clause, provided that in no event will any pricing 

adjustment be made that would exceed the maximum permissible under any law in effect at the time of the adjustment.

There will be no adjustment for orders placed during the first period specified below. Pricing will thereafter be eligible 

for adjustment during the second and any succeeding performance period(s). For each performance period after the first, 

a percentage figure will be calculated as described below and that figure will be the economic price adjustment for that 

entire next period.

Pricing adjustments under this clause are not applicable to reimbursable postage or transportation costs, or to paper, if 

paper prices are subject to adjustment by separate clause elsewhere in this contract.

For the purpose of this clause, performance under this contract will be divided into successive periods. The first period 

will extend from February 1, 2024 to January 31, 2025, and the second and any succeeding period(s) will extend for 12 

months from the end of the last preceding period, except that the length of the final period may vary. The first day of the 

second and any succeeding period(s) will be the effective date of the economic price adjustment for that period.

Pricing adjustments in accordance with this clause will be based on changes in the seasonally adjusted “Consumer Price 

Index For All Urban Consumers – Commodities Less Food” (Index) published monthly in the CPI Detailed Report by the 

U.S. Department of Labor, Bureau of Labor Statistics.

The economic price adjustment will be the percentage difference between Index averages as specified in this paragraph. 

An index called the variable index will be calculated by averaging the monthly Indexes from the 12-month interval ending 

three (3) months prior to the beginning of the period being considered for adjustment. This average is then compared to 

the average of the monthly Indexes for the 12-month interval ending October 31, 2023, called the base index. The 

percentage change (plus or minus) of the variable index from the base index will be the economic price adjustment for the 

period being considered for adjustment.

The Government will notify the contractor by contract modification specifying the percentage increase or decrease to be 

applied to invoices for orders placed during the period indicated. The contractor shall apply the percentage increase or 

decrease against the total price of the invoice less reimbursable postage or transportation costs and separately adjusted 

paper prices. Payment discounts shall be applied after the invoice price is adjusted.

If the Government exercises an option, the extended contract shall be considered to include this economic price 

adjustment clause.

Note: Economic price adjustments are not cumulative and are to be applied to original bid prices only.

PAPER PRICE ADJUSTMENT 

Paper prices charged under this contract will be adjusted in accordance with “Table 9 - Producer Price Indexes and 

Percent Changes for Commodity Groupings and Individual Items” in Producer Price Indexes report, published by the 

Bureau of Labor Statistics (BLS), as follows:

1. BLS code 0913 for “All Paper” will apply to all paper required under this contract. 

2. The applicable index figures for the month of December 2023 will establish the base index.

3. There shall be no price adjustment for the first three months of the contract.

4. Price adjustments may be monthly thereafter, but only if the index varies by an amount (plus or minus) 

exceeding 5% by comparing the base index to the index for that month which is two months prior to the month 

being considered for adjustment.
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5. Beginning with order placement in the fourth month, index variances will be calculated in accordance with the 

following formula:

XX − base index

base index × 100 = _____%

where X = the index for that month which is two months prior to the month being considered for adjustment.

6. The contract adjustment amount, if any, will be the percentage calculated in 5 above less 5%.

7. Adjustments under this clause will be applied to the contractor’s bid price(s) for Line Items IV. Paper (a) (1) 

and (2) and (b) (1) through (3) in the Schedule of Prices and will be effective on the first day of any month 

for which prices are to be adjusted.

The Contracting Officer will give written notice to the contractor of any adjustments to be applied to invoices for orders 

placed during months affected by this clause.

In no event, however, will any price adjustment be made which would exceed the maximum permissible under any law in 

effect at the time of the adjustment. The adjustment, if any, shall not be based upon the actual change in cost to the 

contractor, but shall be computed as provided above.

The contractor warrants that the paper prices set forth in this contract do not include any allowance for any contingency to 

cover anticipated increased costs of paper to the extent such increases are covered by this price adjustment clause.

PRE-AWARD SURVEY 

In order to determine the responsibility of the prime contractor or any subcontractor, the Government reserves the right to 

conduct an on-site pre-award survey at the contractor’s/subcontractor’s facility or to require other evidence of technical, 

production, managerial, financial, and similar abilities to perform, prior to the award of a contract.

The Pre-Award Survey will include a review of all subcontractors involved, along with their specific functions; and the 

contractor’s/subcontractor’s, personnel, data handling, production, security and other requirements outlined in 

“Section 5 – CMS Security Specifications”.

Attending the pre-award survey may be representatives from the Government Publishing Office and/or the Centers for 

Medicare and Medicaid Services. The Government reserves the right to conduct post-award surveys of the same nature as 

needed.

As part of the financial determination, the contractor in line for award may be required to provide one or more of the 

following financial documents:

1. Most recent Profit and Loss Statement

2. Most recent Balance Sheet

3. Statement of Cash Flows

4. Current official bank statement

5. Current lines of credit (with amounts available)

6. Letter of commitment from paper supplier(s)

7. Letter of commitment from any subcontractor (as applicable)

The documents will be reviewed to validate that adequate financial resources are available to perform the contract 

requirements. Documents submitted will be kept confidential and used only for the determination of responsibility by the 

Government. Failure to provide the requested information in the time specified by the Government may result in the 

Contracting Officer not having adequate information to reach an affirmative determination of responsibility.

 
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ASSIGNMENT OF JACKETS, PURCHASE AND PRINT ORDERS 

A GPO jacket number will be assigned and a purchase order issued to the contractor to cover work performed. The 

purchase order will be supplemented by an individual “print order” for each job placed with the contractor. The print 

order, when issued, will indicate the quantity to be produced and any other information pertinent to the particular order.

ORDERING 

Items to be furnished under the contract shall be ordered by the issuance of print orders by the Government. Orders may 

be issued under the contract from February 1, 2024 through January 31, 2025 plus for such additional period(s) as the 

contract is extended. All print orders issued hereunder are subject to the terms and conditions of the contract. The 

contract shall control in the event of conflict with any print order. A print order shall be “issued” upon notification by the 

Government for purposes of the contract when it is electronically transmitted or otherwise physically furnished to the 

contractor in conformance with the schedule.

REQUIREMENTS 

This is a requirements contract for the items and for the period specified herein. Shipment/delivery of items or 

performance of work shall be made only as authorized by orders issued in accordance with the clause entitled “Ordering”. 

The quantities of items specified herein are estimates only and are not purchased hereby. Except as may be otherwise 

provided in this contract, if the Government’s requirements for the items set forth herein do not result in orders in the 

amounts or quantities described as “estimated”, it shall not constitute the basis for an equitable price adjustment under this 

contract.

Except as otherwise provided in this contract, the Government shall order from the contractor all the items set forth which 

are required to be purchased by the Government activity identified on page 1. 

The Government shall not be required to purchase from the contractor, requirements in excess of the limit on total orders 

under this contract, if any.

Orders issued during the effective period of this contract and not completed within that time shall be completed by the 

contractor within the time specified in the order, and the rights and obligations of the contractor and the Government 

respecting those orders shall be governed by the terms of this contract to the same extent as if completed during the 

effective period of this contract.

If shipment/delivery of any quantity of an item covered by the contract is required by reason of urgency prior to the 

earliest date that shipment/delivery may be specified under this contract, and if the contractor will not accept an order 

providing for the accelerated shipment/delivery, the Government may procure this requirement from another source.

The Government may issue orders which provide for shipment/delivery to or performance at multiple destinations.

Subject to any limitations elsewhere in this contract, the contractor shall furnish to the Government all items set forth 

herein which are called for by print orders issued in accordance with the “Ordering” clause of this contract.

POST-AWARD CONFERENCE 

In order to ensure that the Contractor fully understands the total requirements of the job as indicated in these 

specifications, Government representatives will conduct a telephone conference with the Contractor’s representatives. 

The purpose of the conference will be to discuss and review all aspects of the contractor’s production plan, to establish 

coordination of all internal and external operations required to complete the contract, and CMS to determine the 

appropriate level of security investigation.

The Post-Award Conference will include a review of all subcontractors involved along with their specific functions, and 

the contractor’s/subcontractor’s personnel, production, security and other requirements outlined in the CMS Data Use 

Agreement.

 
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POST-AWARD TEST 

The contractor being considered for award shall be required to demonstrate their ability to print the items required in these

specifications at the requisite quality level by completing a Post-Award Test.

The Government reserves the right to waive the Post-Award Test if there is other evidence that, in the opinion of the 

Contracting Officer, indicates that the contractor being considered for award has the capability to successfully produce the 

items required.

The contractor will be required to submit total of up to 500 English sample kits and 150 Spanish sample kits using the test 

files provided prior to production. The test files will include English and Spanish versions of Mailing Kits 1 through 4

that require a stuffer as directed by the Government. 

Each sample kit must be a completed, ready-to-mail package and include a printed and imaged Medicare Premium Bill

(CMS-500/CMS-500ID and/or CMS-20143/CMS-20143ID or as indicated at the Post-Award Conference) including the 

scan line (as applicable), a return envelope, mailing envelope, and bill stuffer.

Each sample must be produced in accordance with the specifications. The furnished records will simulate the various 

types of premium bills/statements the contractor may be expected to print and mail. Each sample must be constructed as 

specified and must be of the size, kind, and quality that the contractor will furnish.

During the term of the contract, the contractor may be required to provide additional prior to production samples of the 

CMS-500 only, including the Scan Line to be tested by CMS’ Medicare Premium Collection Center (MPCC).

Within 10 workdays after receiving the data files, the contractor must submit the samples for evaluation to: HHS/CMS, 

Attn: Mark Rydberg, 7500 Security Blvd., SL-12-18, Baltimore, MD 21244-1850.

The samples produced during the test run will be checked for adherence to all specifications. The Government will 

approve, conditionally approve, or disapprove these test copies within 14 workdays of the receipt thereof.

Approval or conditional approval shall not relieve the contractor from complying with the specifications and all other 

terms and conditions of the contract. A conditional approval shall state any further action required by the contractor. A 

notice of disapproval shall state the reasons therefore.

If these copies are disapproved by the Government due to printer’s errors, the Government may require the contractor to 

submit additional copies for inspection and testing, in the time and under the terms and conditions specified in the notice 

of disapproval. Such additional copies shall be furnished, and necessary changes made, at no additional cost to the 

Government.

In the event these additional copies are disapproved by the Government due to printer’s errors, the contractor may be 

deemed to have failed to make delivery within the meaning of the default clause in which event this contract shall be 

subject to termination for default.

If the ability to achieve the necessary quality is not satisfactorily demonstrated, the contract may result in Termination of 

Default, see Contract Clause 20. Default (GPO Pub. 310.2). The charge for the test run will be performed at no cost to the 

Government. All samples must be manufactured at the same facilities and on the same equipment used for producing 

contract production quantities.

ADDITIONAL E-MAILED BID SUBMISSION PROVISIONS 

The Government will not be responsible for any failure attributable to the transmission or receipt of the e-mailed bid

including, but not limited to, the following: 

1. Illegibility of bid. 

2. E-mails over 75 MB may not be received by GPO due to size limitations for receiving e-mails.
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3. The bidder’s e-mail provider may have different size limitations for sending e-mail; however, bidders are 

advised not to exceed GPO’s stated limit.

4. When the e-mail bid is received by GPO, it will remain unopened until the specified bid opening time. 

Government personnel will not validate receipt of the e-mailed bid prior to bid opening. GPO will use the 

prevailing Columbus, OH time and the exact time that the e-mail is received by GPO’s e-mail server as the 

official time stamp for bid receipt at the specified location.

PAYMENT 

Contractor’s billing invoice must be itemized in accordance with the line items in the “Section 4. - Schedule of Prices.” 

Failure to itemize invoice may result in delay of payment.

Submitting all invoices for payment via the GPO fax gateway (if no samples are required) utilizing the GPO barcode 

coversheet program application is the fastest method of getting paid. The information for using this method can be found 

at: https://winapps.access.gpo.gov/fms/vouchers/barcode/instructions.html. 

Invoices may also be mailed to: U.S. GPO, Office of Financial Management, Attn: Comptroller, Stop: FMCE; 

Washington, DC 20401.

For more information about the billing process refer to the General Information of the Office of Finance web page located 

at: https://www.gpo.gov.

At time of invoicing, the contractor shall submit a copy of the print order, contractor’s invoice, and all mailing and/or 

delivery receipts via e-mail to: infonortheast@gpo.gov, lprice@gpo.gov, and to mark.rydberg@cms.hhs.gov. 
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SECTION 2. – SPECIFICATIONS 

SCOPE 

These specifications cover the production of Medicare Premium Bill Mailing Kits requiring such operations as 

electronic prepress, proofs, prior-to-production samples, printing, computer imaging, perforating (as applicable), 

folding (as applicable), inserting into envelopes, and mailing. 

TITLE 

Medicare Premium Bill Mailing Kits

MAILING KITS 

There are four Medicare Premium Bill Mailing Kits: 

• Mailing Kit 1: Medicare Premium Bill Kit (CMS-500)

• Mailing Kit 2: Medicare Premium Bill PBID Kit (CMS-500ID)

• Mailing Kit 3: Medicare Easy Pay Premium Statement Kit (CMS-20143)

• Mailing Kit 4: Medicare Easy Pay Premium Statement PBID Kit (CMS-20143ID)

Mailing Kits 1 and 2 will contain a Form (CMS-500 or CMS-500ID), a Mailing Envelope, a Reply Envelope, and 

may or may not contain Bill Stuffers.

Mailing Kits 3 and 4 will contain a Form (CMS-20143 or CMS-20143ID), a Mailing Envelope, and may or may 

not contain Bill Stuffers. Reply Envelopes are not required. 

Each Mailing Kit will have two print size versions and two language versions for a total of 16 versions. Each 

version will have identical content but formatted for print size and language. Each version is sent to a specific 

population of Medicare Beneficiaries.

• Version A: Standard Print, English

• Version B: Standard Print, Spanish

• Version C: Large Print, English

• Version D: Large Print, Spanish

NOTE: Additional Mailing Kits may be added during the term of the contract. When added, new Mailing Kits 

will have Versions A through D as described above.

MAILING KIT FORMS 

Each Mailing Kit will have either a Medicare Premium Bill or a Medicare Easy Pay Premium Statement. Each 

form may require the contractor to make updates to the base forms throughout the term of the contract. 

• Mailing Kit 1: CMS-500

• Mailing Kit 2: CMS-500ID

• Mailing Kit 3: CMS-20143

• Mailing Kit 4: CMS-20143ID

MAILING KIT BILL STUFFERS 

Bill Stuffers contain specific information that CMS is required to provide to certain segments of the Medicare 

Beneficiary population. Each Bill Stuffer will have Versions, A, B, C, and D. Most Bill Stuffers will be:
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• CMS-11659 and CMS-11659S: “Understanding Your Medicare Premium Bill (CMS-500)”

• CMS-12112 and CMS-12112S: “Understanding Your Medicare Easy Pay Statement (CMS-20143)”

• Premiums Stuffer: “An Important Message About Your Medicare Premiums”

CMS-11659/CMS-11659S and CMS-12112/CMS-12112S are anticipated to remain the same during the term of 

the contract. Premiums Stuffers provide Medicare premiums information which are anticipated to change each 

year. See additional information under “Printing” and “Pre-Printing of Static Data”.

The individual print order will indicate which, if any, Bill Suffer is required and will provide instructions for 

determining which Mailing Kit (Medicare Beneficiary) receives which Bill Stuffer(s). Any combination of 0, 1, 

or 2 Bill Stuffers per Mailing Kit may be required. Some orders will not require Bill Stuffers for any Mailing Kit.

• CMS-11659 will only be required when indicated and for Mailing Kits 1 and 2 and Versions A and C.

• CMS-11659S will only be required when indicated and for Mailing Kits 1 and 2 and Versions B and D.

• CMS-12112 will only be required when indicated and for Mailing Kits 3 and 4 and Versions A and C.

• CMS-12112S will only be required when indicated and for Mailing Kits 3 and 4 and Versions B and D.

• Premium Stuffers will only be required when indicated and for Mailing Kits 1 to 4 and Versions A to D.

Additional Bill Stuffers may be ordered on the contract. Anticipate letter size (portrait or landscape orientation) 

in single ink color or legal size (landscape orientation) in two ink colors.

ENVELOPES 

Mailing Kits 1 through 4 will require Mailing Envelopes. Mailing Kits 1 and 2 will require Reply Envelopes. 

Mailing Kits 3 and 4 will not require Reply Envelopes.

FREQUENCY OF ORDERS 

One order per month. Each order will indicate the quantity of each Mailing Kit. It is anticipated that each version 

of each Mailing Kit will be ordered on the same monthly print order. 

QUANTITY 

Standard Print Kits: Approximately 2,100,000 to 2,500,000 kits per order. Large Print Kits: Up to 1,000 kits per 

order. 

English Kits: Approximately 2,100,000 to 2,500,000 kits per order. Spanish Kits: Approximately 40,000 to 

46,000 kits per order.

The average quantity for both English and Spanish may increase up to approximately 20% per year during the 

term of the contract.

Mailing Kit

Version A: 

Standard Print 

English. Average 

Kits per Order

Version B: 

Standard Print 

Spanish. Average 

Kits per Order

Version C: 

Large Print 

English. Average 

Kits per Order

Version D: Large 

Print Spanish. 

Average Kits per 

Order

Mailing Kit 1: 

CMS-500

1,000,000 to 

1,500,000 25,000 to 50,000 5 to 150 5 to 150

Mailing Kit 2: 

CMS-500ID 5 to 150 5 to 150 5 to 150 5 to 150

Mailing Kit 3: 

CMS-20143

500,000 to 

1,000,000 5,000 to 50,000 5 to 150 5 to 150

Mailing Kit 4: 

CMS-20143ID 5 to 150 5 to 150 5 to 150 5 to 150
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It is anticipated that individual print orders will have varying quantities and combinations of Bill Stuffers for each 

Mailing Kit and some Mailing Kits may not have Bill Stuffers.

Anticipate the following “Understanding...Bill/Statement” Bill Stuffers:

Orders per Year

Percentage of Mailing Kits with 

“Understanding...Bill/Statement” Stuffer

1 to 3 orders 20% to 25% of all Mailing Kits

1 to 3 orders 5% to 15% of all Mailing Kits

Up to 6 orders No Stuffers

Anticipate the following “Premiums” Bill Stuffers:

Orders per Year

Percentage of Mailing Kits with 

“Premiums” Stuffer

5 to 6 orders 15% to 25% of all Mailing Kits

3 to 4 orders 26% to 50% of all Mailing Kits

1 to 2 orders 51% to 100% of all Mailing Kits

Up to 3 orders No Stuffers

PAGES 

Mailing Kits 1 through 4 and Versions A and B will have 2 to 6 pages per Mailing Kit. 

Mailing Kits 1 through 4 and Versions C and D will have 8 to 22 pages per Mailing Kit.

A Mailing Envelope will be required for all Mailing Kits. A Reply Envelope will be required for Mailing Kits 1 

and 2 only.

The table below shows a typical page count for each Mailing Kit.

Additional Letter Size, Single Ink Bill Stuffers or Legal Size, Two Ink Bill Stuffers may be ordered.

It is anticipated that Bill Stuffers for Versions C and D (Large Print format) will have Letter Size, Single Ink Bill 

Stuffers only. Anticipate portrait and landscape orientations.

Forms and Stuffers

Versions A and B: Standard Print, 

English and Spanish

Versions C and D: Large Print 

English and Spanish

Forms (All Kits):

CMS-500/500ID

CMS-20143/20143ID

2 pages (2 images) 8 pages (7 images)

Stuffers (Kits 1 and 2):

CMS-11659 (Eng)

CMS-11659S (Spa)

2 pages (2 images) 10 pages (9 images)

Stuffers (Kits 3 and 4):

CMS-12112 (Eng)

CMS-12112S (Spa)

2 pages (2 images) 6 pages (6 images)

Stuffers (All Kits):

Premiums Stuffer

2 pages (2 images)

Versions A and B:

English on front, Spanish on back

4 pages (3 images)

Version C: English Only

Version D: Spanish Only
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TRIM SIZES: 

Trim Size 8-1/2 × 11” (portrait orientation)

• All CMS Forms: All Kits, Versions A and B

• Letter Size, Single Ink Bills Stuffers, usually “Premium” Bill Stuffers: All Kits, Versions A and B and 

Versions C and D

Trim Size 11 × 8-1/2” (landscape orientation): 

• All CMS Forms, All Kits, Versions C and D

• Letter Size, Single Ink Bill Stuffers, usually CMS-11659/11659S Bill Stuffers: Mailing Kits 1 and 2, 

Versions C and D

• Letter Size, Single Ink Bill Stuffers, usually CMS-12112/12112S Bill Stuffers: Mailing Kits 3 and 4, 

Versions C and D

Trim Size 14 × 8-1/2” (landscape orientation)

• Legal Size, Two Ink Bill Stuffers, usually CMS-11659/11659S Bill Stuffers, Mailing Kits 1 and 2, 

Versions A and B

• Legal Size, Two Ink Bill Stuffers, usually CMS-12112/12112S Bill Stuffers, Mailing Kits 3 and 4, 

Versions A and B

ENVELOPE TRIM SIZES: 

• Mailing Envelope, All Kits, Versions A and B: 4-1/8 × 9-1/2”

• Mailing Envelope, All Kits, Versions C and D: 9-1/2 × 12”

• Reply Envelopes, Mailing Kits 1 and 2, Versions A and B and Versions C and D: 3-7/8 × 8-7/8”. 

GOVERNMENT TO FURNISH 

Upon award, contractor must obtain approval from CMS IT Security for access to CMS computer systems. 

Contractor will need an Internet browser, the browser must be most recent version of Chrome, or GIS-compatible 

secure File Transfer Protocol Client (FTP).

• Complete record specifications for each Mailing Kit, Exhibit A. 

• CMS Scan Line Specifications, Exhibit B. 

• OCR Specifications for Scan Line (Mailing Kits 1 and 2 only), Exhibit C. 

• Bill/Statement Form/Envelope Templates (23 total art files, see “Template Art Files” table below). 

• CMS Mailing Permits G28 and Free Matter. Contractor is cautioned that mailing indicum will be 

furnished and may only be used for the purpose of producing printed envelopes under this contract.

• GPO Form 952 (Desktop Publishing – Disk Information). 

• PS Form 3615 (Mailing Permit Application and Customer Profile). 

Once a month the following individual order files will be furnished via e-mail or TIBCO/GENTRAN mailbox:

• GPO Form 2511, Print Order in PDF via e-mail. 

• Bill Stuffer file(s) (specific instructions listed on the individual print order) in PDF or Microsoft Word via 

e-mail. 

• Variable data file for each Mailing Kit. Anticipate 16 data files via electronic file transmission (EFT) 

using TIBCO or GENTRAN mailbox.

 
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EXHIBITS 

Exhibits D through L indicate the type of products ordered under this contract. The Exhibits are not exact 

representations of or all-inclusive of the products ordered under this contract.

TEMPLATE ART FILES 

A visual of all Mailing Kits may be furnished at the post-award conference. At the time of award, the following 

files will be furnished via e-mail in PDF or Microsoft Word file format:

Form/Envelope

Large Print 

English Art File

Large Print 

Spanish Art File

Standard Print 

English Art File

Standard Print 

Spanish Art File

Form CMS-500 PDF PDF PDF PDF

Form CMS-500ID PDF PDF PDF PDF

Form CMS-20143 PDF PDF PDF PDF

Form CMS-20143ID PDF PDF PDF PDF

9 × 12” Mailing 

Envelope PDF N/A N/A N/A

4-1/8 × 9-1/2” 

Mailing Envelope PDF PDF PDF PDF

3-7/8 × 8-7/8” Reply 

Envelope N/A N/A PDF PDF

SOFTWARE 

Files for static data will be furnished in PDF or Microsoft Word file formats. Program will be on either Apple or 

Microsoft Windows platform. Contractor will be required to support all current and future upgrades for platform 

and software.

Fonts: All printer and screen fonts will be furnished. The contractor is cautioned that furnished fonts are the

property of the Government and/or its originator. All furnished fonts are to be eliminated from the contractor’s 

archive immediately after completion of the contract.

SPECIAL SOFTWARE CONSIDERATION 

Office graphics (e.g., files from Presentation, Word Processing, or other non-publishing applications) are 

furnished for this procurement. Additional system work may be required to produce output as per specifications. 

If supplied by the Government, a black and white visual will be used as the standard for page integrity. 

Contractor must ensure that the job outputs exactly as the furnished visual.

The contractor will not receive additional compensation, or time for common errors associated with the output of 

Office Graphics files. Common errors include, but are not limited to: 1) Color issues and Shifts (RGB color 

data, no spot colors, loss of Black plate), 2) Page Integrity (text reflow), 3) Missing prepress features (e.g., 

bleeds, trim marks), or 4) Loss of text characters from graphic elements.

Upon completion of the order, the contractor must furnish final production native application files (digital 

deliverables) with the furnished material. The digital deliverables must be an exact representation of the final 

printed product and shall be returned on the same type of storage media as was originally furnished.

NOTE: If discrepancies are found on the Government-furnished material(s), the contractor must contact Mark 

Rydberg at (410) 786-6959, before starting production.

 
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ADDITIONAL FURNISHED MATERIAL INFORMATION 

Identification markings such as register marks, ring folios, rubber stamped jacket numbers, commercial 

identification marks of any kind, etc., except GPO imprint, form number, and revision date, carried on copy or 

film, must not appear on finished product.

CONTRACTOR TO FURNISH 

All materials and operations, other than those listed under “Government to Furnish”, necessary to produce the 

products in accordance with these specifications.

The contractor must have the capability to accept and process electronically transmitted data.

The contractor may maintain surplus inventory of pre-printed static data. The contractor is cautioned that 

reimbursement will only be made for actual mailed pieces. See “Pre-Printing of Static Data” under “Printing” 

below.

ELECTRONIC PREPRESS 

Immediately upon receipt and prior to image processing, the contractor shall perform a basic check (preflight) of 

the furnished media and publishing files to assure correct output of the required reproduction image. Any errors, 

media damage, or data corruption that might interfere with proper file image processing must be reported to

mark.rydberg@cms.hhs.gov and the GPO Northeast Region Contracting Officer prior to further performance. It 

is recommended that the contractor output files on the same platform (i.e. PC); no additional time or 

compensation will be given for errors commonly associated with file output from a different platform.

The contractor shall create or alter any necessary trapping, set proper screen angles and screen frequency, and 

define file output selection for the imaging device being utilized. Furnished files must be imaged as necessary to 

meet the assigned quality level.

The contractor shall create or alter any necessary trapping, set proper screen angles and screen frequency, and 

define file output selection for the imaging device being utilized. Furnished files must be imaged as necessary to 

meet the assigned quality level.

PROOFS 

The contractor will be responsible for performing all necessary proofreading to ensure that the proofs submitted 

are in conformity with the furnished copy and record specifications.

CMS-500, CMS-500ID, CMS-20143, AND CMS-20143ID 

Form Templates 

One set of “Press Quality” PDF “soft” proofs (for content only) of each form template will be required on the first 

production order and with each new form template. No PII/PHI is to be included in any of the template proofs.

Contractor to maintain approved proofs for the term of the contract or until revised artwork is provided, 

whichever comes first.

Approved proofs will serve as the “Specified Standards” until new proofs are approved or unless Prior-toProduction Samples are ordered. E-mail proofs to mark.rydberg@cms.hhs.gov and lprice@gpo.gov. 

Data Merge 

It is anticipated that 16 data files will be furnished, one for each Version of each Mailing Kit.
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Upon receipt of data files for each print order, the contractor is to acknowledge receipt of data files and confirm 

the record count of each data file. 

Within 1 workday of receipt of files, contractor is required to submit “Press Quality” PDF “soft” proofs (for 

content only) of variable data forms from each furnished data file. 

It is anticipated that each data file will require 50 sets of proofs. The individual print order will indicate if another 

quantity is required.

In the same e-mail as the PDF Proofs of Notices, contractor must also submit the corresponding source data files 

(also known as a “data dump”) in a Microsoft Excel format in the same sequence as the submitted Notice proofs. 

Phone notification at (410) 786-3038 to confirm receipt of e-mail. Include Jacket # and Requisition #, Program # 

and Print Order # with title. 

Both the PDF Proofs of the variable data forms and the “data dump” file must be submitted via e-mail and be 

encrypted, password protected, and PK zipped. E-mail proofs to Mark Rydberg at the following e-mail address 

mark.rydberg@cms.hhs.gov. 

CAUTION: PDF Proofs of variable data forms and the “data dump” file, as described in “Data Merge” above

will contain PII/PHI. All required Security Protocols in Sections 1 and 5 of this contract must be followed. 

The e-mail containing these files is not to be sent to any e-mail address that has not been authorized by CMS.

If CMS finds errors during the proofing process, the contractor must make all corrections and submit additional 

proofs along with the corresponding source data files. This process will be repeated until the contractor submit 

samples that CMS considers to be error-free.

All “Press Quality” PDF “soft” proofs to be produced using the same Raster Image Processor (RIP) that will be 

used to produce the final printed product. Proofs will be evaluated for variable and static data, text flow, and 

image position.

STUFFERS 

When indicated on the print order, one set of “Press Quality” PDF “soft” proofs (for content only) of each Bill 

Stuffer file furnished. Due to legislative processes, some orders may have more than one version of a Bill Stuffer 

that will require proofs but proofs for only one version will be approved. Contractor will be reimbursed for each 

set of proofs ordered by the Government.

Contractor to maintain approved proof for the term of the contract or until revised Stuffer artwork is provided, 

whichever comes first. Approved proof will serve as the “Specified Standard” until a new proof is approved. 

E-mail proofs to mark.rydberg@cms.hhs.gov and lprice@gpo.gov. 

ENVELOPES 

One set of “Press Quality” PDF “soft” proofs (for content only) for each of the 7 envelope styles will be required 

on the first production order. Contractor to maintain approved proof for the term of the contract or until revised 

envelope artwork is provided, whichever comes first. Approved proof will serve as the “Specified Standard” until 

a new proof is approved. E-mail proofs to mark.rydberg@cms.hhs.gov and lprice@gpo.gov. 

PROOF APPROVALS 

The Government will approve or disapprove the samples within the number of workdays as defined under 

“Schedule”. Notification will be given by e-mail from Mark Rydberg. Approval or disapproval will not relieve 

the contractor of complying with the specifications and all other terms and conditions of the contract. Additional 

e-mail samples may be required if image samples are disapproved.
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If any contractor’s errors are serious enough in the opinion of the GPO to require revised proofs, the revised 

proofs are to be provided at no expense to the Government. No extra time can be allowed for this reproofing; 

such operations must be accomplished within the original production schedule allotted in the specifications.

The contractor must not print/image prior to receipt of an OK to print.

PRIOR-TO-PRODUCTION SAMPLES 

Prior-to-Production Samples of each Mailing Kit are expected to be ordered on one to two print orders per year.

The sample requirement for this contract is not less than 50 printed construction samples as indicated on the 

individual print order. Each sample shall be printed and constructed as specified and must be of the size, kind, 

and quality that the contractor will furnish.

Samples will be inspected and tested and must comply with the specifications as to construction, kind, and quality 

of materials.

APPROVAL FOR PRIOR-TO-PRODUCTION SAMPLES 

Prior to the commencement of production of the contract production quantity, the contractor shall submit samples 

to the Baltimore, MD address indicated on the individual print order. Samples with PII/PHI must be submitted in 

accordance with Security Protocols defined in Sections 1 and 5 of this contract. Samples will be tested for 

conformance of material(s) and/or for usage on the specified equipment and/or for construction. The container 

and accompanying documentation shall be marked PREPRODUCTION SAMPLES and shall include the GPO 

jacket, purchase order, and program numbers. The samples must be submitted in sufficient time to allow 

Government testing of the samples and production and shipment in accordance with the shipping schedule.

The Government will approve, conditionally approve, or disapprove the samples within 7 workdays of the receipt 

thereof. Approval or conditional approval shall not relieve the contractor from complying with the specifications 

and all other terms and conditions of the contract. A conditional approval shall state any further action required

by the contractor. A notice of disapproval shall state the reasons therefor.

If the samples are disapproved by the Government, the Government, at its option, may require the contractor to 

submit additional samples for inspection and test, in the time and under the terms and conditions specified in the 

notice of rejection. Such additional samples shall be furnished, and necessary changes made, at no additional cost 

to the Government and with no extension in the shipping schedule. The Government will require the time 

specified above to inspect and test any additional samples required.

In the event the additional samples are disapproved by the Government, the contractor shall be deemed to have 

failed to make delivery within the meaning of the default clause in which event this contract shall be subject to 

termination for default, provided however, that the failure of the Government to terminate the contract for default 

in such event shall not relieve the contractor of the responsibility to deliver the contract quantities in accordance 

with the shipping schedule.

In the event the Government fails to approve, conditionally approve, or disapprove the samples within the time 

specified, the Contracting Officer shall automatically extend the shipping schedule in accordance with Contract 

Clause 12, “Notice of Compliance With Schedules,” of GPO Contract Terms (GPO Publication 310.2, effective 

December 1, 1987 (Rev. 01-18)). 

Manufacture of the final product prior to approval of the sample submitted is at the contractor’s risk. Samples 

will not be returned to the contractor. All costs, including the costs of all samples shall be included in the contract 

price for the production quantity.

All samples shall be manufactured at the facilities in which the contract production quantities are to be 

manufactured.

 
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STOCK/PAPER 

The specifications of all paper furnished must be in accordance with those listed herein or listed for the 

corresponding JCP Code numbers in the “Government Paper Specification Standards No. 13” dated September 

2019 found at https://www.gpo.gov/docs/default-source/forms-and-standards-files-for-vendors/vol_13.pdf

CMS FORMS AND BILL STUFFERS: 

White Uncoated Text, basis weight: 25 × 38”, 500 sheets, 50 lbs. equal to JCP Code A60 and the applicable OCR 

Optical Specs, Exhibit C, for Form CMS-500 and Form CMS-500ID. 

MAILING AND REPLY ENVELOPES: 

White Writing Envelope (or Wove), basis weight: 17 × 22”, 500 sheets, 20 or 24 lbs., equal to JCP Code V-20.

PRINTING 

At contractor’s option, the product may be produced via conventional offset or digital printing provided that all 

printing and imaging quality standards are maintained. Final output must be a minimum of 150-line screen and at 

a minimum resolution of 2400 × 2400 dpi × 1 bit or 600 × 600 dpi × 8-bit depth technology. Digital device must 

have a RIP that provides an option for high quality color matching such as Device Links Technology and/or ICC 

Profiles.

PRE-PRINTING OF STATIC DATA 

At the contractor’s option, contractor may preprint any static images from static data to keep a stock on hand or 

print the static image when they receive the orders. It is anticipated that the contractor may keep no more than a 

2-month supply on hand for Bill Stuffers and a 3-month supply of Envelopes. Contractor is not to pre-print CMS 

Forms.

Although the static images will generally remain the same from order to order, changes may need to be made 

from time to time. The Government will provide the contractor with as much advance notice as possible.

The inventory of stock on hand for monthly supply should be coordinated with the Government when the contract 

is within 3 months of expiration. Contractor is cautioned that reimbursement will only be made for actual 

quantities mailed.

CMS FORMS 

Versions A and B (Standard Print, English and Spanish) forms print variable data on the face in black and close 

match of Pantone 186 Red ink and print static data on the back in black ink. The contractor is cautioned that the 

backers of each form are different.

Versions C and D (Large Print, English and Spanish) forms print variable data on pages 1 through 7 in black ink 

and page 8 is blank. The contractor is cautioned that each form is different.

Variable Data Printing 

Variable Data Printing (VDP), also known as Variable Imaging (VI) or as Variable Information Printing (VIP) is 

required for each CMS Form (CMS-500, CMS-500ID, CMS-20143, and CMS-20143ID). Contractor will be 

required to produce variable data from TIBCO/GENTRAN files (variable data files). At contractor’s option, the 

variable imaging to be produced by either waterproof ink jet spray or high-density laser at a minimum 600 × 600 

dpi.

Contractor to variable image forms in accordance with the attached record specifications. There are 

approximately 40 fields of variable data in the data files. The 40 fields will populate the face side of the forms. 
Medicare Premium Bill Mailing Kits Page 24 of 92

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Face prints variable data in black ink and plus close match to Pantone 186 Red. Back prints static data in black 

ink.

Address Formatting Requirements

The Variable Image address fields will be four to seven lines. Address placement, format, fonts and IMb 

barcodes must meet USPS automated mail processing equipment compatibility standards and comply with current 

U.S. Postal Service (USPS) Address Quality Standards. These standards are in accordance with appropriate 

USPS rules and regulations including USPS Domestic Mail Manual (DMM) for domestic and International Mail 

Manual (IMM) for International addresses that are in effect at the time of mailing. Note, the type font must be 

one of the USPS accepted and verified Multiline Optical Character Reader (MLOCR) readable type.

It is the contractor’s responsibility to assure that only the computer-generated address and IMb and other 

applicable USPS barcodes/markings on the mail piece will be visible through the window in the envelope and that 

only one complete Mailing Kit is inserted into each envelope.

Scan Line

CMS-500 and CMS-500ID forms, Formats A and B only, print with a scan line. The scan line shall be printed 

using the OCR-A, Size I Font. The OCR printing shall read continuously on a Banctec X2 series transport. The 

reject rate due to manufacturing deficiencies shall not exceed 1.5 percent of the items when run on the specified 

reading equipment. A form is a reject when its OCR print cannot be correctly deciphered on the first pass through 

the specified reading equipment.

The CMS-500 and CMS-500ID forms, Formats A and B only, are to be scanned on a BancTec X2 series 

transport. The contractor must also convert the 5-digit Zip codes on the furnished cartridges to Zip + four, plus 

the 2-digit state code, plus check digit, and corresponding Postnet bar code.

Images are to be scanned on a Banctec X2 series transport. The contractor must also convert the 5-digit Zip 

codes on the furnished cartridges to Zip + four, plus the 2-digitstate code, plus check digit, and corresponding

Postnet bar code. NOTE: At the contractor’s option, in addition to the variable data, the entire base form may

also be computer imaged in red and black ink.

Performance of Finished Product

The contractor must guarantee that the Premium Bill Forms CMS-500 and CMS-500ID, Formats A and B only,

produced under this contract will function properly at top speed when processed on a “BancTec X2” series 

transport scanner.

There are 4 versions of CMS-500 and CMS-500ID and 4 versions of CMS-20143 and CMS-20143ID. There are 

two language formats for each version, English and Spanish. There are two font sizes for each version, standard 

print and large print. Each order will consist of a combination of versions, languages, and font sizes.

The Premium Bill Form CMS-500 and CMS-500ID (Formats A and B only) is a two-sided scannable document; 

therefore, the contractor must have the capability to print simultaneously, on both sides.

The form is perforated near the bottom half of the sheet to serve as a payment coupon for the beneficiary.

There are different types of Bills identified in the Bill Record Specifications. Forms are printed in English and 

Spanish. Periodically, it is necessary to change a message on the reverse side of the Medicare bills (CMS-500 and 

CMS-500ID).

 
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BILL STUFFERS 

Versions A and B, All Kits 

Bill Stuffers for Versions A and B (Standard Print, English and Spanish) will print static data with 8-1/2 × 11” or 

8-1/2 × 14” trim sizes.

Legal Size, Two Ink Bill Stuffers, usually “Understanding...Bill/Statement” Stuffers CMS-11659 (English), 

CMS-11659S (Spanish), CMS-12112 (English), and CMS-12112S (Spanish), print face and back in black ink and 

Pantone 186 Red, 8-1/2 × 14” trim size.

Letter Size, Single Ink Bill Stuffers, usually the “Premiums” Stuffer, print face and back in a single ink (usually 

black) with 8-1/2 × 11” trim size and usually with English on the front and Spanish on the back.

Versions C and D, All Kits 

Bill Stuffers for Versions C and D (Large Print, English and Spanish) will print static data in black ink only with 

8-1/2 × 11” (portrait orientation) or 11 × 8-1/2” (landscape orientation).

CMS-11659/11659S (“Understanding...Bill”) print face and back in black ink with 11 × 8-1/2” trim size, 10 

pages. Pages 1 through 9 print in black ink, page 10 is blank.

CMS-12112/12112S (“Understanding...Statement”) print face and back in black ink with 11 × 8-1/2” trim size, 6 

pages. Pages 1 through 6 print in black ink, no blanks.

The “Premiums” Stuffer prints face and back in black ink with 8-1/2 × 11” trim size. The English only version 

prints pages 1 through 3 in black ink, page 4 is blank. The Spanish only version prints pages 1 through 3 in black 

ink, page 4 is blank.

MAILING ENVELOPES 

Print return address, message, and mailing permit in black ink on envelope face and text matter on envelope back 

after manufacturing. Government owned and furnished mailing indicum may only be used for the purpose of 

producing printed envelopes under this contract. Print in accordance with USPS Regulations for Domestic and 

International Mail.

Print security tint on inside of envelope in black ink. The contractor may use jumbled character design or stock 

design for security tint. Stock design must be approved by CMS. No proprietary design or company logos 

allowed for design of security tint.

Security tint must guarantee that the product will ensure complete opacity and prevent show through of any 

material contained therein and cannot bleed on to enclosed material.

Mailing Envelopes have five different art files:

• Domestic formats:

o Standard Print, English

o Standard Print, Spanish

o Large Print, English

• International formats:

o Standard Print, English

o Standard Print, Spanish

The printing and format on the envelopes may change during the term of the contract. Copy changes may come 

with up to 30 calendar day notice.

 
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REPLY ENVELOPES 

Print address, rules, Intelligent Mail Barcode (IMB), and FIM bars in black ink on envelope face. Back of 

constructed envelope prints in black ink. Print in accordance with USPS Regulations for Domestic and 

International Mail.

Print security tint on inside of envelope in black ink. The contractor may use jumbled character design or stock 

design for security tint. Stock design must be approved by CMS. No proprietary design or company logos 

allowed for design of security tint.

Security tint must guarantee that the product will ensure complete opacity and prevent show through of any 

material contained therein and cannot bleed on to enclosed material. Reply Envelopes will be inserted into 

contractor furnished envelopes with printed indicia as part of Mailing Kits 1 and 2. Reply Envelopes are not 

required for Mailing Kits 3 and 4.

Reply Envelopes have two different art files:

• Domestic formats:

o Standard Print, English

o Standard Print, Spanish

The printing and format on the envelopes may change during the term of the contract. Copy changes may come 

with up to 30 calendar day notice.

MARGINS 

Margins will be as indicated on the print order or furnished copy.

CONSTRUCTION 

CMS FORMS 

At the contractor’s option, all CMS Forms trim four sides or, if the contractor runs on continuous feed, the 

contractor is responsible for trimming or bursting all four sides.

CMS Forms for Mailing Kits 1 and 2 Versions A and B (CMS-500 and CMS-500ID) will perforate one line. 

Perforate (slit or slot without ink) horizontally 3-2/3” from the bottom edge of the form. No perforation on 

Mailing Kits 3 and 4 (CMS-20143 and CMS-20143ID).

CMS Forms for Mailing Kits 1 through 4, Versions A and B will fold to 8-1/2 x 3-2/3” using two parallel folds, 

contractor’s option for “C” or “Z” pattern, with the mailing address facing out. 

CMS Forms for Mailing Kits 1 through 4, Versions C and D do not perforate and do not fold.

BILL STUFFERS 

Trim four sides.

Bill Stuffers with 8-1/2 × 11” trim size for Mailing Kits 1 through 4, Versions A and B will fold to 8-1/2 × 3-2/3” 

using two parallel folds, contractor’s option for “C” or “Z” pattern with title of Stuffer facing out.

Bill Stuffers with 8-1/2 × 14” trim size for Mailing Kits 1 through 4, Versions A and B will fold to 8-1/2 × 3-2/3” 

using three parallel folds, anticipate “Z” pattern, with CMS logo and title of Stuffer facing out.

Bill Stuffers for Mailing Kits 1 through 4, Versions C and D do not fold.

 
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MAILING ENVELOPES 

The 4-1/8 × 9-1/2” envelopes are to be manufactured as open side with diagonal seams and a fully gummed flap. 

Die-cut a 4 × 1-1/4” window with slightly rounded corners located 1/2” from the right edge and 5/8” from the 

bottom edge. The 4” dimension of the window to be parallel to the 9-1/2” dimension of the envelope. Cover the 

window with a suitable, clear, polystyrene material securely glued to the inside.

The 9 × 12” envelopes are to be manufactured as open side with side seams and a fully gummed flap. Die-cut a

2-3/4 × 4-5/8” window with slightly rounded corners located 6-1/2” form left edge and 3-1/2” from bottom edge 

of envelope. The 4-5/8” dimension of the window to be parallel to the 12” dimension of the envelope. Cover the 

window with a suitable, clear, polystyrene material securely glued to the inside.

REPLY ENVELOPES 

Manufacture open side with diagonal seams and a fully gummed flap. No window required. 

ASSEMBLY 

MAILING KIT 1 AND 2, VERSIONS A AND B 

After printing and construction, folded CMS Form is to be inserted into mailing envelope with the address 

readable through the window. Insert Reply Envelope behind CMS Form. Insert Bill Stuffer(s) behind Reply 

Envelope, as applicable. 

MAILING KIT 3 AND 4, VERSIONS A AND B 

After printing and construction, folded CMS Form is to be inserted into Mailing Envelope with the address 

readable through the window. Insert Bill Stuffer(s) behind CMS Form, as applicable. No reply envelope.

MAILING KIT 1 AND 2, VERSIONS C AND D 

After printing and construction, flat CMS Form is to be inserted flat and loose (no staples) into Mailing Envelope 

with the address readable through the window. Insert Reply Envelope behind CMS Form. Insert Bill Stuffer(s)

flat and loose (no staples) behind Reply Envelope, as applicable. 

MAILING KIT 3 AND 4, VERSIONS C AND D 

After printing and construction, flat CMS Form is to be inserted flat and loose (no staples) into Mailing Envelope 

with the address readable through the window. Insert Bill Stuffer(s) flat and loose (no staples) behind CMS 

Form, as applicable. No reply envelope.

DISTRIBUTION 

Mail f.o.b. Contractor’s city. Individual Mailing Kits will be mailed monthly to approximately 2,100,000 to 

2,400,000, domestic addresses using Government-furnished and contractor printed “First Class Postage and Fees 

Paid Permit” indicia and to approximately 3,000 to 4,000 international addresses.

The contractor must mail on a flow basis as production runs are completed on all print orders.

The contractor must provide all mailing materials, as well as all labeling and marking, as necessary to fulfill 

mailing and distribution requirements. Noncompliance with the packing and labeling instructions will be cause 

for the Government to take corrective action in accordance with GPO Pub. 310.2.
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All envelopes for domestic addresses will have a printed CMS Mail Postage and Fees Paid permit. The contractor 

is cautioned to use the permit imprint only for mailing material produced under this contract. Using the CMS 

address information as provided, the contractor is required to obtain the maximum USPS postage discounts 

possible in accordance with the USPS First Class mail automated mail discount structure in effect at the time of 

mailing. In compliance with USPS Mail Preparation & Sortation Regulations, all mail must be appropriately 

marked and supported with the documentation necessary to ensure USPS acceptance.

Mailing Envelopes must be prepared and sealed in a manner that will ensure acceptance, security, and safe 

delivery by the U.S. Postal Service. Gather each piece and insert into mailing envelope, and seal.

TAP TEST 

In addition, USPS has instituted a verification procedure called a “tap” test. This test is used to screen all 

mailings with barcoded inserts for proper barcode spacing within the envelope window. USPS will randomly 

select samples from a mailing and tap the pieces on their left right and bottom edges to test whether the barcode 

maintains a minimum spacing of 1/8 inch between the barcode and the left and right edges of the window, at least 

1/25 inch between the barcode and the bottom edge of the mail piece. Mail pieces are not to be tapped upside 

down (i.e., on their top edge).

DOMESTIC MAIL 

Addresses for this mailing come from a government-maintained file. For this mailing, CMS will provide 

certificates indicating that the addresses have been matched against both the USPS required Coding Accuracy 

Support System (CASS) and National Change of Address (NCOA) software within the past 95 calendar days.

In the event the CASS and NCOA certification has expired, the contractor may be required to provide the 

certification prior to mailing. Reimbursement for this service will be made via contract modification.

Contractor sponsored address data enhancements to secure postal discount MUST NOT negatively affect 

deliverability and/or omit/change any required address field as provided by CMS address files. It is the 

contractor’s responsibility to keep up to date on all USPS requirements.

All domestic copies mailed must conform to the appropriate regulations in the U.S. Postal Service manuals for 

domestic presorted First-Class mail as applicable and must be prepared for the most cost-effective mailing 

rate/class obtainable presorting for maximum postal automation discounts (as applicable). The placement and 

application of the IMB barcodes must not compromise any applicable USPS addressing/imprinting requirements.

Intelligent Mail Barcode (IMb) 

During the term of this contract, CMS mailers will be required to meet USPS requirements for using IMb to 

access automation postal rates for presort first class mail. Full Service IMb will be required for Domestic Mail 

only. The successful bidder must understand and be able to implement all mail preparation requirements enacted 

by the Postal Service related to using full-service IMb. The requirements include, but are not limited to, preparing 

Intelligent Mail barcodes for the mail, trays and containers meeting USPS quality acceptance standards.

Experience with assigning unique numbers for each mail piece, preparing electronic manifests, making electronic 

appointments, producing revised tray/pallet label formats and other similarly detailed IMb requirements as

mandated by the Postal Service is essential.

The IMb must appear in the address block of the inserted item and show through the window area of the mailing 

envelope. Printing or imaging of the IMb on the envelope is NOT permissible.

Contractor may be responsible for any postage fees related to undeliverable letters caused by print quality control 

issues.
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Secure Destruct

Secure Destruct (SD) applies to Domestic Standard Print and Puerto Rican records. The Secure-Destruct process 

does not apply to Large Print portion of orders or any International mailing records.

The Mailer Identifier (MID) is a field within the Intelligent barcode (IMb) that is used to identify mailers 

requiring SD. Require Full Service IMb – ACS SD Option 2 – Service Type ID 335. CMS to provide the MID 

code to contractor for use in the IMb.

The metrics for SD to be encoded in the IMb is as follows:

• MID Code

• Single Source ACS

• Service Type Identifiers (STIDs) 335

o Forward Mail pieces 

o Undeliverable Mail pieces 

o Note: Change-of-Address (COA’s) life cycle is for 12 months. During months 13-18 the mail 

pieces will be destroyed and an Address Correction Service (ACS) notice is generated and coded 

as Forwarding Order Expired (FOE) on the record. A notice will contain the reason for nondelivery as a UAA Code.

U.S. Postal Service - Electronic Product Fulfillment (EPF)

The U.S. Postal Service uploads daily the SD metrics of mail-pieces. Contractor to downloaded daily these 

metrics from the password protected EPF site.

There are two files per day, one is the delimited SD file and the other contains a fixed length file of the SD plus 

ACS metrics.

The contractor retains these downloaded files in a secure location until the mailing for the 3561-S is 100% 

complete for that week of domestic mail pieces.

The contractor must provide all mailing materials, as well as all labeling and marking, as necessary to fulfill 

mailing and distribution requirements.

Noncompliance with the packing and labeling instructions will be cause for the government to take corrective 

action in accordance with GPO Pub. 310.2.

All copies mailed must conform to the appropriate regulations in the U.S. Postal Service manuals for domestic 

presorted First-Class mail (note exception to Foreign addresses). Mail as applicable. Mail must be prepared for 

the most cost-effective mailing rate/class obtainable, including ZIP + 4, bar-coding, and presorting for maximum 

postal automation discounts (as applicable).

The placement and application of the full-service Intelligent Mail Barcode (IMb) must not compromise any 

applicable USPS addressing/imprinting requirements.

All mailed copies must be sorted using the ZIP + 4 code. Exception – Puerto Rican Package Addresses must only 

display +4 codes from CMS provided address file.

INTERNATIONAL MAIL 

If the mailing meets the qualifications for International Priority Airmail (IPA), it should be processed through IPA 

in accordance with postal rules and regulations in effect for USPS IPA at the time of the mailing.

To maximize postage savings, the contractor shall sort to the IPA Rate Group 1 through 15.
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3561-S (01/25)

Pieces not qualifying for the IPA Rate Group Levels of discount shall be prepared at the Worldwide Nonpresorted rate level and any remaining pieces that do not meet IPA qualifications will be sorted by individual 

country rules according to the USPS IMM in effect at the time of the mailing.

ADDITIONAL DISTRIBUTION REQUIREMENTS 

Any address/mail management related questions/issues should be directed to the following CMS personnel:

• Erika Grant, at (410) 786-1067, or e-mail Erika.Grant@cms.hhs.gov 

• Cynthia Williams, at (410) 786-6071, or e-mail cynthia.williams@cms.hhs.gov 

Contractor may be responsible for any postage fees related to undeliverable letters caused by print quality control 

issues.

Certificate of Conformance 

When using Permit Imprint Mail the contractor must complete GPO Form 712 - Certificate of Conformance (Rev. 

1-85) supplied by GPO and the appropriate mailing statement or statements supplied by USPS.

Mailing Statements 

Contractor must complete and supply all copies of all USPS 3602’s and GPO 712’s along with the GPO invoice 

to CMS within 2 workdays of USPS certification.

Contractor must e-mail copies to Mark Rydberg at Mark.Rydberg@cms.hhs.gov and to Erika Grant at 

erika.grant@cms.hhs.gov. 

All mailed copies must be sorted using the ZIP + 4 code, in order to achieve the most economical First-Class

rates, as applicable by the number of pieces being mailed.

The contractor must submit two copies of the appropriate U.S. Postal Service mailing statement (e.g., 3602, 3602-

G, 3541, etc.) to the entry post office for each mailing. 

In the upper right corner of the mailing statement, contractor must include a unique GPO identification number 

beginning with the jacket number followed by a sequential number for each form used for mailings performed for 

the term of the contract (e.g. XXX-XXX-1, XXX-XXX-2, XXX-XXX-3, etc.).

The contractor must e-mail the verified mailing statement, containing postage computations, within 24 hours of 

receipt from the U.S. Postal Service to mark.rydberg@cms.hhs.gov, Erika.grant@cms.hhs.gov, 

infonortheast@gpo.gov, and lprice@gpo.gov. 

Within 7 workdays after completion of each mailing, the contractor is to return all Government Furnished 

Material to HHS/CMS, 7500 Security Blvd., Room SL-12-18, Baltimore, MD 21244-1850 Attn: Mark Rydberg. 

Inside delivery is required to the room number indicated.

All expenses incidental to pick up and returning furnished materials, submitting proofs, and furnishing sample 

copies, must be borne by the contractor.

 
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REPORTING 

RECORD COUNT AND SCHEDULE CONFIRMATION 

Upon receipt of data files, the contractor shall confirm via e-mail to Mark.Rydberg@cms.hhs.gov, 

lprice@gpo.gov, and infonortheast@gpo.gov that the files and record counts available in TIBCO MFT or the 

Gentran (back up mailbox) match the counts on the print order and must confirm that the mailing schedule can be 

met.

This confirmation must be completed within 2 hours after receipt of the print order.

On-time mailing of the Mailing Kits is an integral part of this contract. Failure to meet the mailing date may 

result in fines and penalties assessed to CMS. Any assessed fines or penalties may be charged to the contractor 

under GPO Contract Terms (GPO Pub. 310.2) Contract Clause 21. Actual Damages.

Failure to provide schedule confirmation and failure to meet the mailing date may result in termination of 

contract, see Contract Clause 20. Default (GPO Pub. 310.2).

CONTRACTOR’S QUALITY ASSURANCE REPORTS 

As part of the Contractor’s Quality Assurance Plan, under “Automated System”, the contractor generates a final 

automated Audit Report and Summary Report which provides information that all mail pieces have been scanned 

after insertion and verifying that all pieces inserted into the mailing envelope for each Print Order are accounted 

for. 

The summary report will contain the sequence number range for a particular Print Order, show all sequence 

numbers were scanned and accounted for after all mail pieces are inserted, and event information on any spoiled 

or missing pieces verifying that they were scanned and accounted for.

The report to also summarize a state-by-state count of all letters mailed, identifying state and numbers of copies 

mailed to that state.

Contractor to work with the CMS and GPO after award with layout and functionality of these reports. 

TRACKER REPORT 

A production and mailing report is to be completed and e-mailed to mark.rydberg@cms.hhs.gov, 

infonortheast@gpo.gov, and lprice@gpo.gov after each day’s production and immediately after final USPS 

receipt of mail pieces.

The report is to include the number of records and the applicable Bill Stuffer(s) for each Mailing Kit and each 

Version of each Mailing Kit. 

The report must track each record through file transmission, print production, inserting, and mailing. The layout 

and naming convention of this report will be finalized at the post-award conference.

SECURE DESTRUCT IMB 

After mailing is complete on a weekly basis, contractor to generate two Excel spreadsheet reports (one is the 

delimited SD file and the other contains a fixed length file of the SD plus ACS metrics) from these EPF files and 

e-mailed to mark.rydberg@cms.hhs.gov. 

Contractor must be retained these Excel spreadsheet reports for 12 months after mailing date and must be made 

available to CMS and/or GPO for auditing of contractor performance upon request.
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First Report metrics to be downloaded daily and puts into the weekly reports will be linked to the Print Order as 

follows:

• Short Date field of the EPF download results for each day.

• UAA Code for each Beneficiary Name for each mail piece that was SD. 

• How many pieces delivered.

• How many pieces were forward, ACS counts and ACS forwarding counts.

Second Report provides beneficiary level data of ACS/SD records that contain PII.

CERTIFICATE OF DESTRUCTION 

The contractor will at times be required to destroy physical item(s) without a government representative onsite. 

Contractor to provide CMS and GPO a PDF of the certificate of destruction which must include the following: 

item(s) destroyed, count (number of item(s) destroyed), date when occurred, and person(s) that witness the 

destruction of government property.

Contractor to provide certificate of destruction of Quality Pulls and of any other item the government may ask to 

be destroyed.

SCHEDULE 

Adherence to this schedule must be maintained.

Contractor must not start production of any job prior to receipt of the individual print order (GPO Form 2511).

The following schedule begins the workday after notification of the availability of print order(s) and furnished

Material. The workday after notification will be the first workday of the schedule:

Complete production and mailing must be made within five (5) workdays.

On-time mailing of the Mailing Kits is an integral part of this contract. Failure to meet the mailing date may 

result in fines and penalties assessed to CMS. Any assessed fines or penalties may be charged to the contractor 

under GPO Contract Terms (GPO Pub. 310.2) Contract Clause 21. Actual Damages.

Failure to provide schedule confirmation and failure to meet the mailing date may result in termination of 

contract, see Contract Clause 20. Default (GPO Pub. 310.2).

The contractor must mail completed pieces on a flow basis as production runs are completed in accordance with 

permit requirements for mailing.

Unscheduled material such as shipping instructions, delivery lists, etc., will be furnished with each order or 

shortly thereafter. In the event such information is not received in due time, the contractor will not be relieved of 

any responsibility in meeting the shipping schedule because of failure to request such information.
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SECTION 3. – DETERMINATION OF AWARD 

The Government will determine the lowest bid by applying the prices offered in the “Schedule of Prices” to the 

following units of production which are the estimated requirements to produce 12 month’s production under this 

contract. These units do not constitute, nor are they to be construed as, a guarantee of the volume of work which 

may be ordered under this contract for a like period of time.

The following item designations correspond to those listed in the “Schedule of Prices”. 

 I. (a) 25,685

 (b) 15,961

(c) 25,647

 (d) 38

 II. (a) 8 

 (b) 8 

(c) 24

 (d) 11

 (e) 46

 (f) (1) 4 

(2) 1 

(3) 2 

 (g) (1) 4 

(2) 4 

(3) 4 

(4) 4 

 III. 1. (a) (1) 48

(2) 15,961

 (b) (1) 48

(2) 9,720

(c) (1) 11

(2) 7,218

 (d) (1) 24

(2) 2,050

2. (a) (1) 96

(2) 4 

 (b) (1) 22

(2) 1 

(c) (1) 24

(2) 1 

3. (a) (1) 12

(2) 25,685

 (b) (1) 12

(2) 4 

(c) (1) 12

(2) 15,963

 IV. (a) (1) 32,923

(2) 2,050

 (b) (1) 15,963

(2) 25,685

(3) 4 

V. (a) 25,681

 (b) 4 
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3561-S (01/25)

PAGE 34 IS BLANK
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3561-S (01/25)

SECTION 4 – SCHEDULE OF PRICES 

Bids offered are f.o.b. contractor’s city by Government permit imprint.

Prices must be submitted for the entire term of the contract and bids qualified for a lesser period will not be 

considered.

Prices must include the cost of all required materials and operations for each item listed in accordance with these 

specifications.

Bidder must make an entry in each of the spaces provided. Bids submitted with any obliteration, revision, or 

alteration of the order and manner of submitting bids, may be declared nonresponsive.

An entry of NC (No Charge) shall be entered if bidder intends to furnish individual items at no charge to the 

Government.

Bids submitted with NB (No Bid), NA (Not Applicable), or blank spaces for an item may be declared 

nonresponsive.

The Contracting Officer reserves the right to reject any offer that contains prices for individual items of 

production (whether or not such items are included in the Determination of Award) that are inconsistent or 

unrealistic in regard to other prices in the same offer or to GPO prices for the same operation if such action would 

be in the best interest of the Government.

All vouchers submitted to the GPO shall be based on the most economical method of production.

Fractional parts of 1,000 will be prorated at the 1,000 rate.

I. PRE-PRESS AND DATA PROCESSING: Prices must include the cost of all required materials and 

operations for the following operations. 

 (a) Data Processing (includes all operations required for

 “Electronic Pre-Press” and “Reporting” (other than

IMb and SD operations), all Mailing Kits and Versions).............. per 1,000 records........... $ _________ 

 (b) Create Scan Line for CMS-500 and CMS-500ID, 

Versions A and B .......................................................................... per 1,000 records........... $ _________ 

 (c) Domestic Mail Preparation (includes all IMb and

SD operations), all Mailing Kits and Versions.............................. per 1,000 addresses....... $ _________ 

 (d) International Mail Preparation, all Mailing Kits and Versions...... per 1,000 addresses....... $ _________ 

____________

(Initials)

E-MAIL THIS PAGE TO: INFONORTHEAST@GPO.GOV
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3561-S (01/25)

SCHEDULE OF PRICES

II. PROOFS AND PRIOR-TO-PRODUCTION SAMPLES: Prices must include the cost of all required 

materials and operations for the following operations. 

(a) CMS Form Templates (no variable data),

Versions A and B .......................................................................... each proof...................... $ _________ 

 (b) CMS Form Templates (no variable data),

Versions C and D .......................................................................... each proof...................... $ _________ 

 (c) Bill Stuffers, 8-1/2 x 14” trim size with 2 inks,

 Versions A and B .......................................................................... each proof...................... $ _________ 

 (d) Bill Stuffers, 8-1/2 x 11” trim size with single ink,

Versions A and B .......................................................................... each proof...................... $ _________ 

(e) Bill Stuffers, 8-1/2 x 11” trim size with single ink,

Versions C and D .......................................................................... each proof...................... $ _________ 

 (f) Envelopes: 

 (1) Mailing Envelopes, 4-1/8 x 9-1/2” trim size........................... each proof...................... $ _________ 

 (2) Mailing Envelopes, 9 x 12” trim size...................................... each proof...................... $ _________ 

 (3) Reply Envelopes, 3-7/8 x 8-7/8” trim size.............................. each proof...................... $ _________ 

 (g) Prior-to-Production Samples: 

 (1) Mailing Kits 1 and 2 (CMS-500 and CMS-500ID),

Versions A and B.................................................................... each set.......................... $ _________ 

 (2) Mailing Kits 1 and 2 (CMS-500 and CMS-500ID), 

Versions C and D.................................................................... each set.......................... $ _________ 

 (3) Mailing Kits 2 and 3 (CMS-20143 and CMS-20143ID),

Versions A and B.................................................................... each set.......................... $ _________ 

 (4) Mailing Kits 2 and 3 (CMS-20143 and CMS-20143ID)

Versions C and D.................................................................... each set.......................... $ _________ 

____________

(Initials)

E-MAIL THIS PAGE TO: INFONORTHEAST@GPO.GOV
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SCHEDULE OF PRICES

III. PRINTING/IMAGING, CUTTING TO SIZE, AND CONSTRUCTION: Prices must include the cost of 

press makeready and running, printing in up to two ink color(s), cutting to size, perforating, and folding. The cost 

of all required paper (including makeready and running spoilage) must be charged under Item IV.

Makeready and/or Running Charges

Setup Charges Per 1,000 Copies

(1) (2) 

1. Version A, Standard Print English and

Version B, Standard Print Spanish: 

(a) CMS-500 and CMS-500ID (includes printing

Scan Line and perforating and folding forms) .....each form............ $ __________ $ _________ 

 (b) CMS-20143 and CMS-20143ID (includes

 folding forms) ...................................................... each form............ $ __________ $ _________ 

(c) 8-1/2 x 11” Single Ink Bill Stuffers (includes

folding stuffers).................................................... each stuffer ......... $ __________ $ _________ 

 (d) 8-1/2 x 14” Two Ink Bill Stuffers (includes

folding stuffers).................................................... each stuffer ......... $ __________ $ _________ 

2. Version C, Large Print English and

Version D, Large Print Spanish:

(a) CMS Forms.......................................................... each form............ $ __________ $ _________ 

 (b) Bill Stuffers, 6 pages............................................ each stuffer ......... $ __________ $ _________ 

 (c) Bill Stuffers, 10 pages.......................................... each stuffer ......... $ __________ $ _________ 

3. Envelopes (includes construction):

(a) Mailing Envelopes, 4-1/8 x 9-1/2” trim size........each envelope ..... $ __________ $ _________ 

 (b) Mailing Envelopes, 9 x 12” trim size...................each envelope ..... $ __________ $ _________ 

(c) Reply Envelopes, 3-7/8 x 8-7/8” trim size...........each envelope ..... $ __________ $ _________ 

____________

(Initials)

E-MAIL THIS PAGE TO: INFONORTHEAST@GPO.GOV
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3561-S (01/25)

SCHEDULE OF PRICES

IV. PAPER: Payment for all paper supplied by the contractor under the terms of these specifications, as ordered 

on the individual print orders, will be based on the net number of leaves furnished for the product(s) ordered. The 

cost of any paper required for makeready or running spoilage must be included in the prices offered.

(a) White Uncoated Text, 50 lbs., equal to JCP Code A60:

 (1) 8-1/2 x 11” Trim Size .......................................................... per 1,000 leaves................ $ _________ 

 (2) 8-1/2 x 14” Trim Size ......................................................... per 1,000 leaves................ $ _________ 

 (b) White Writing/Wove Envelope, 20 or 24 lbs., equal to

JCP Code V20:

 (1) 3-7/8 x 8-7/8” trim size ........................................................ per 1,000 envelopes.......... $ _________ 

 (2) 4-1/8 x 9-1/2” trim size ....................................................... per 1,000 envelopes.......... $ _________ 

 (3) 9 x 12” trim size .................................................................. per 1,000 envelopes.......... $ _________ 

V. GATHERING, INSERTING, AND PREPARING FOR MAILING: Prices must include the cost of all 

required materials and operations except for perforating and folding (chargeable under Item III). 

(a) All Mailing Kits, Versions A and B Only

with or without Reply Envelopes, with

or without Bill Stuffers............................................................... per 1,000 mailers.............. $ _________ 

 (b) All Mailing Kits, Versions C and D Only

with or without Reply Envelopes, with

or without Bill Stuffers............................................................... per 1,000 mailers.............. $ _________ 

____________

(Initials)

E-MAIL THIS PAGE TO: INFONORTHEAST@GPO.GOV
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SCHEDULE OF PRICES

SHIPMENT(S): Shipments will be made from: City ________________________, State ____________

The city(is) indicated above will be used for evaluation of transportation charges when transportation charges are 

specified to be a factor in determination of award. If no shipping point is indicated above, it will be deemed that 

the bidder has selected the city and state shown below in the address block, and the bid will be evaluated and the 

contract awarded on that basis. If shipment is not made from evaluation point, the contractor will be responsible 

for any additional shipping costs incurred.

DISCOUNTS: Discounts are offered for payment as follows: ______ Percent calendar days. See 

Article 12 “Discounts” of Solicitation Provisions in GPO Contract Terms (Publication 310.2).

AMENDMENT(S): Bidder hereby acknowledges amendment(s) number(ed) _________________________

BID ACCEPTANCE PERIOD: In compliance with the above, the undersigned agree, if this bid is accepted 

within____ calendar days (60 calendar days unless a different period is inserted by the bidder) from the date for 

receipt of bids, to furnish the specified items at the price set opposite each item, delivered at the designated 

points(s), in exact accordance with specifications.

NOTE: Failure to provide a 60-day bid acceptance period may result in expiration of the bid prior to award.

BIDDER’S NAME AND SIGNATURE: Unless specific written exception is taken, the bidder, by signing and 

submitting a bid, agrees with and accepts responsibility for all certifications and representations as required by the 

solicitation and GPO Contract Terms – Publication 310.2. When responding by email, fill out and return one 

copy of all pages in “SECTION 4. – SCHEDULE OF PRICES,” including initialing/signing where indicated. 

Valid electronic signatures will be accepted in accordance with the Uniform Electronic Transactions Act, §2. 

Electronic signatures must be verifiable of the person authorized by the company to sign bids.

Failure to sign the signature block below may result in the bid being declared non-responsive.

BIDDER:

________________________________________________________________________________________

(Contractor Name) (GPO Contractor’s Code)

________________________________________________________________________________________

(Street Address)

________________________________________________________________________________________

(City – State – Zip Code)

By ______________________________________________________________________________________

(Printed Name, Signature, and Title of Person Authorized to Sign this Bid) (Date)

________________________________________________________________________________________

(Person to be Contacted) (Telephone Number) (E-mail) 

LOCATION OF POST OFFICE: All mailing will be made from the Post Office located at:

Street Address 

City State Zip 

THIS SECTION FOR GPO USE ONLY

Contracting Officer Review ____________ Date ___________ Certifier ______________Date____________ 

E-MAIL THIS PAGE TO: INFONORTHEAST@GPO.GOV
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SECTION 5. – CMS SECURITY SPECIFICATIONS 

THE REQUIREMENTS UNDER THIS SECTION WILL BE ADMINISTERED BY A CMS SECURITY 

REPRESENTATIVE (NAME AND CONTACT INFORMATION WILL BE PROVIDED AT TIME OF AWARD).

CMS INFORMATION SECURITY (APR 2013) 

FAR 52.227-14 Rights in Data – General (May 2014).

As prescribed in 27.409(b) (1), insert the following clause with any appropriate alternates:

(a) Definitions. As used in this clause--

“Computer database” or “database” means a collection of recorded information in a form capable of, and for the purpose 

of, being stored in, processed, and operated on by a computer. The term does not include computer software.

“Computer software”— 

(1) Means

(i) Computer programs that comprise a series of instructions, rules, routines, or statements, regardless of the media 

in which recorded, that allow or cause a computer to perform a specific operation or series of operations; and

(ii) Recorded information comprising source code listings, design details, algorithms, processes, flow charts, 

formulas, and related material that would enable the computer program to be produced, created, or compiled.

(2) Does not include computer databases or computer software documentation.

“Computer software documentation” means owner’s manuals, user’s manuals, installation instructions, operating 

instructions, and other similar items, regardless of storage medium, that explain the capabilities of the computer 

software or provide instructions for using the software.

“Data” means recorded information, regardless of form or the media on which it may be recorded. The term 

includes technical data and computer software. The term does not include information incidental to contract 

administration, such as financial, administrative, cost or pricing, or management information.

“Form, fit, and function data” means data relating to items, components, or processes that are sufficient to enable 

physical and functional interchangeability, and data identifying source, size, configuration, mating, and attachment 

characteristics, functional characteristics, and performance requirements. For computer software it means data 

identifying source, functional characteristics, and performance requirements but specifically excludes the source 

code, algorithms, processes, formulas, and flow charts of the software.

“Limited rights” means the rights of the Government in limited rights data as set forth in the Limited Rights Notice 

of subparagraph (g) (2) if included in this clause.

“Limited rights data” means data, other than computer software, that embody trade secrets or are commercial or 

financial and confidential or privileged, to the extent that such data pertain to items, components, or processes 

developed at private expense, including minor modifications.

“Restricted computer software” means computer software developed at private expense and that is a trade secret; is 

commercial or financial and is confidential or privileged; or is copyrighted computer software, including minor 

modifications of the computer software.

“Restricted rights,” as used in this clause, means the rights of the Government in restricted computer software, as set 

forth in a Restricted Rights Notice of paragraph (g) if included in this clause, or as otherwise may be provided in a 

collateral agreement incorporated in and made part of this contract, including minor modifications of such computer 

software.
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3561-S (01/25)

“Technical data” means recorded information (regardless of the form or method of the recording) of a scientific or 

technical nature (including computer databases and computer software documentation). This term does not include 

computer software or financial, administrative, cost or pricing, or management data or other information incidental 

to contract administration. The term includes recorded information of a scientific or technical nature that is included 

in computer databases (See 41 U.S.C. 116).

“Unlimited rights” means the right of the Government to use, disclose, reproduce, prepare derivative works, 

distribute copies to the public, and perform publicly and display publicly, in any manner and for any purpose, and to 

have or permit others to do so.

(b) Allocation of rights.

(1) Except as provided in paragraph (c) of this clause, the Government shall have unlimited rights in—

(i) Data first produced in the performance of this contract;

(ii) Form, fit, and function data delivered under this contract;

(iii) Data delivered under this contract (except for restricted computer software) that constitute manuals or 

instructional and training material for installation, operation, or routine maintenance and repair of items, 

components, or processes delivered or furnished for use under this contract; and

(iv) All other data delivered under this contract unless provided otherwise for limited rights data or restricted 

computer software in accordance with paragraph (g) of this clause.

(2) The Contractor shall have the right to—

(i) Assert copyright in data first produced in the performance of this contract to the extent provided in paragraph 

(c) (1) of this clause;

(ii) Use, release to others, reproduce, distribute, or publish any data first produced or specifically used by the 

Contractor in the performance of this contract, unless provided otherwise in paragraph (d) of this clause;

(iii) Substantiate use of, add or correct limited rights, restricted rights, or copyright notices and to take other 

appropriate action, in accordance with paragraphs (e) and (f) of this clause; and

(iv) Protect from unauthorized disclosure and use those data that are limited rights data or restricted computer 

software to the extent provided in paragraph (g) of this clause.

(c) Copyright—

(1) Data first produced in the performance of this contract.

(i) Unless provided otherwise in paragraph (d) of this clause, the Contractor may establish, without prior approval 

of the Contracting Officer, claim to copyright in scientific and technical articles based on or containing data first 

produced in the performance of this contract and published in academic, technical or professional journals, 

symposia proceedings or similar works. The prior, express written permission of the Contracting Officer is 

required to assert copyright in all other data first produced in the performance of this contract.

(ii) When authorized to assert copyright to the data, the Contractor shall affix the applicable copyright notices of 17 

U.S.C. 401 or 402, and acknowledgment of Government sponsorship (including contract number).

(iii) For data other than computer software, the Contractor grants to the Government, and others acting on its behalf, 

a paid-up, nonexclusive, irrevocable worldwide license in such copyrighted data to reproduce, prepare 

derivative works, distribute copies to the public, and perform publicly and display publicly, by or on behalf of 

the Government. For computer software, the Contractor grants to the Government and others acting on its 

behalf, a paid-up nonexclusive, irrevocable worldwide license in such copyrighted computer software to 

reproduce, prepare derivative works, and perform publicly and display publicly (but not to distribute copies to 

the public) by or on behalf of the Government.
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3561-S (01/25)

(2) Data not first produced in the performance of this contract. The Contractor shall not, without prior written permission of 

the Contracting Officer, incorporate in data delivered under this contract any data not first produced in the 

performance of this contract unless the Contractor—

(i) Identifies the data; and

(ii) Grants to the Government, or acquires on its behalf, a license of the same scope as set forth in subparagraph (c) 

(1) of this clause or; if such data are restricted computer software, the Government shall acquire a copyright 

license as set forth in subparagraph (g) (4) of this clause (if included in this contract) or as otherwise provided in 

a collateral agreement incorporated in or made part of this contract.

(3) Removal of copyright notices. The Government will not remove any authorized copyright notices placed on data 

pursuant to this paragraph (c), and will include such notices on all reproductions of the data.

(d) Release, publication and use of data. The Contractor shall have the right to use, release to others, reproduce, distribute, 

or publish any data first produced or specifically used by the Contractor in the performance of this contract, except—

(1) As prohibited by Federal law or regulation (e.g., export control or national security laws or regulations);

(2) As expressly set forth in this contract; or

(3) If the Contractor receives or is given access to data necessary for the performance of this contract which contain 

restrictive markings, the Contractor shall treat the data in accordance with such markings unless otherwise 

specifically authorized otherwise in writing by the Contracting Officer.

(e) Unauthorized marking of data.

(1) Notwithstanding any other provisions of this contract concerning inspection or acceptance, if any data delivered 

under this contract are marked with the notices specified in paragraph (g) (3) or (g) (4) of this clause and use of the 

notices is not authorized by this clause, or if such data bears any other restrictive or limiting markings not authorized 

by this contract, the Contracting Officer may at any time either return the data to the Contractor, or cancel or ignore 

the markings. However, pursuant to 41 U.S.C. 4703, the following procedures shall apply prior to canceling or 

ignoring the markings.

(i) The Contracting Officer will make written inquiry to the Contractor affording the Contractor 60 days from 

receipt of the inquiry to provide written justification to substantiate the propriety of the markings;

(ii) If the Contractor fails to respond or fails to provide written justification to substantiate the propriety of the 

markings within the 60-day period (or a longer time approved in writing by the Contracting Officer for good 

cause shown), the Government shall have the right to cancel or ignore the markings at any time after said period 

and the data will no longer be made subject to any disclosure prohibitions.

(iii) If the Contractor provides written justification to substantiate the propriety of the markings within the period set in 

subdivision (e) (1) (i) of this clause, the Contracting Officer will consider such written justification and

determine whether or not the markings are to be canceled or ignored. If the Contracting Officer determines that 

the markings are authorized, the Contractor will be so notified in writing. If the Contracting Officer determines, 

with concurrence of the head of the contracting activity, that the markings are not authorized, the Contracting 

Officer will furnish the Contractor a written determination, which determination shall become the final agency 

decision regarding the appropriateness of the markings unless the Contractor files suit in a court of competent 

jurisdiction within 90 days of receipt of the Contracting Officer’s decision. The Government shall continue to 

abide by the markings under this paragraph (e) (1) (iii) until final resolution of the matter either by the 

Contracting Officer’s determination becoming final (in which instance the Government will thereafter have the 

right to cancel or ignore the markings at any time and the data will no longer be made subject to any disclosure 

prohibitions), or by final disposition of the matter by court decision if suit is filed.

(2) The time limits in the procedures set forth in subparagraph (e) (1) of this clause may be modified in accordance with 

agency regulations implementing the Freedom of Information Act (5 U.S.C. 552) if necessary to respond to a 

request thereunder.
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(3) Except to the extent the Government’s action occurs as the result of final disposition of the matter by a court of 

competent jurisdiction, the Contractor is not precluded by paragraph (e) of this clause from brining a claim, in 

accordance with the Disputes clause of this contract, that may arise as a result of the Government removing or 

ignoring authorized markings on data delivered under this contract.

(f) Omitted or incorrect markings.

(1) Data delivered to the Government without any restrictive markings shall be deemed to have been furnished with 

unlimited rights. The Government is not liable for the disclosure, use, or reproduction of such data.

(2) If the unmarked data has not been disclosed without restriction outside the Government, the Contractor may request, 

within 6 months (or a longer time approved by the Contracting Officer in writing for good cause shown) after 

delivery of such data, permission to have authorized notices placed on qualifying data at the Contractor’s expense, 

and the Contracting Officer may agree to do so if the Contractor—

(i) Identifies the data to which the omitted notice is to be applied;

(ii) Demonstrates that the omission of the notice was inadvertent;

(iii) Establishes that the use of the proposed notice is authorized; and

(iv) Acknowledges that the Government has no liability for the disclosure, use, or reproduction of any data made 

prior to the addition of the notice or resulting from the omission of the notice.

(3) If data has been marked with an incorrect notice, the Contracting Officer may—

(i) Permit correction of the notice at the Contractor’s expense if the Contractor identifies the data and demonstrates 

that the correct notice is authorized, or

(ii) Correct any incorrect notices.

(g) Protection of limited rights data and restricted computer software.

(1) The Contractor may withhold from delivery qualifying limited rights data or restricted computer software that are 

not data identified in paragraphs (b) (1) (i), (ii), and (iii) of this clause. As a condition to this withholding, the 

Contractor shall—

(i) Identify the data being withheld; and

(ii) Furnish form, fit, and function data instead.

(2) Limited rights data that are formatted as a computer database for delivery to the Government shall be treated as 

limited rights data and not restricted computer software.

(3) [Reserved]

(h) Subcontracting. The Contractor shall obtain from its subcontractors all data and rights therein necessary to fulfill the 

Contractor’s obligations to the Government under this contract. If a subcontractor refuses to accept terms affording the 

Government such rights, the Contractor shall promptly notify the Contracting Officer of the refusal and shall not proceed 

with the subcontract award without authorization in writing from the Contracting Officer.

(i) Relationship to patents or other rights. Nothing contained in this clause shall imply a license to the Government under 

any patent or be construed as affecting the scope of any license or other right otherwise granted to the Government.

(end of clause)
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All CMS information shall be protected from unauthorized access, use, disclosure, duplication, modification, diversion, or 

destruction, whether accidental or intentional, in order to maintain the security, confidentiality, integrity, and availability of 

such information. Therefore, if this contract requires the contractor to provide services (both commercial and noncommercial) for Federal Information/Data, to include any of the following requirements:

• Process any Information/Data; or • Store any Information/Data (includes “Cloud” computing services); or

• Facilitate the transport of Information/Data; or

• Host/maintain Information/Data (including software and/or infrastructure developer/maintainers); or • Have access to, or use of, Personally Identifiable Information (PII), including instances of remote access to, or 

physical removal of, such information beyond agency premises or control,

The contractor shall become and remain compliant with the requirements set forth at the CMS Information Security website 

at https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/InformationSecurity/Info- Security-Library-Items/CMS-Information-Security-Contract-Clause-Provision.html. The requirements cover all CMS 

contracts and associated deliverables, which are required on a “per contractor” basis.

The contractor shall ensure that the following Federal information security standards are met for all of its CMS contracts:

Federal Information Security Management Act (FISMA) – FISMA information can be found at 

http://csrc.nist.gov/groups/SMA/fisma/index.html. FISMA requires each Federal agency to develop, document, and 

implement an agency-wide program to provide information security for the information and information systems that support 

the operations and assets of the agency, including those provided or managed by another agency, contractor, or other source; 

and,

Federal Risk and Authorization Management Program (FedRAMP) – FedRAMP information can be found at 

http://www.gsa.gov/portal/category/102371. The FedRAMP is a government-wide program that provides a standardized 

approach to security assessment, authorization, and continuous monitoring for cloud products and services.

The Contractor shall include in all awarded subcontracts the FISMA/FedRAMP compliance requirements set forth at the 

CMS Information Security website at https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-InformationTechnology/InformationSecurity/Info-Security-Library-Items/CMS-Information-Security-Contract-Clause-Provision.html. 
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HIPAA BUSINESS ASSOCIATE CLAUSE (OCT 2014) 

All Protected Health Information (PHI), as defined in 45 C.F.R. §160.103, that is relevant to this Contract, shall be 

administered in accordance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA,” 42 U.S.C. § 

1320d), as amended, as well as the corresponding implementing regulations and this HIPAA Business Associate Clause.

a. Definitions: 

All terms used herein and not otherwise defined, shall have the same meaning as in HIPAA, as amended, and the 

corresponding implementing regulations. Non-HIPAA related provisions governing the Contractor’s duties and 

obligations, such as those under the Privacy Act and any applicable data use agreements, are generally covered 

elsewhere in the Contract.

The following definitions apply to this Contract Clause:

“Business Associate” shall mean the Contractor (and/or the Contractor’s subcontractors or agents) if/when it uses 

individually identifiable health information on behalf of CMS, i.e. PHI, to carry out CMS’ HIPAA-covered 

functions.

“Covered Entity” shall mean the portions of CMS that are subject to the HIPAA Privacy Rule.

“Secretary” shall mean the Secretary of the Department of Health & Human Services or the Secretary’s designee.

b. Obligations and Activities of Business Associate:

Except as otherwise provided in this Contract, Business Associate, as defined above, shall only use or disclose PHI 

on behalf of, or to provide services to, Covered Entity in accordance with this Contract and the HIPAA Privacy and 

Security Rules.

Business Associate shall document in writing the policies and procedures that will be used to meet HIPAA 

requirements. The policies and procedures shall include the following, at a minimum:

1. Business Associate shall not:

i. Use or disclose PHI that is created, received, maintained or transmitted by Business Associate from, or on 

behalf of, Covered Entity other than as permitted or required by this Contract or as required by law;

ii. Sell PHI; or,

iii. Threaten, intimidate, coerce, harass, discriminate against, or take any other retaliatory action against any 

individual for:

A. Filing a complaint under 45 CFR § 160.306;

B. Testifying, assisting or participating in an investigation, compliance review, proceeding or hearing 

under 45 CFR Part 160; or

C. Opposing any act or practice that is unlawful under HIPAA, provided there is a good faith belief that 

the practice is unlawful, the manner of opposition is reasonable, and the opposition does not involve 

the disclosure of PHI in violation of subpart E of Part 164.

2. Business Associate shall:

i. Have a security official who will be responsible for development and implementation of its security 

policies and procedures, including workforce security measures, to ensure proper security awareness and 

training (including security incident response and reporting), and security incident procedures, in 

accordance with this Contract, including this HIPAA Business Associate Clause and the Contract’s clause 

entitled “CMS Information Security.”

ii. Use administrative, physical and technical safeguards to prevent use or disclosure of PHI created, received, 

maintained or transmitted by Business Associate from, or on behalf of Covered Entity only as provided for 

by this Contract. In doing so, it shall implement policies and procedures to address the following and, 

where applicable, ensure that such policies and procedures are also in conformance with this Contract’s 

clause entitled “CMS Information Security:”
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A. Prevent, detect, contain and correct security violations through the use of:

a. Risk analyses (including periodic technical and nontechnical evaluations);

b. Appropriate risk management strategies, including system activity review;

c. Information access procedures for approving individual’s access rights to PHI (including the 

implementation of workforce security measures to ensure continued appropriate role-based access

to PHI), and technical policies and procedures to ensure compliance with grants of access 

(including unique user identification and tracking of users) and;

d. The imposition of sanctions for violations.

B. Limit physical access to its electronic information systems and the facility or facilities in which they 

are housed.

C. Implement policies, procedures and physical security measures that will limit access to PHI through 

workstations and other devices, including access through mobile devices.

D. Implement media controls covering the movement of devices containing PHI within or outside of the 

Business Associate’s facility as well as the disposal and reuse of media containing PHI.

E. Implement appropriate administrative, physical and technical safeguards that reasonably and 

appropriately protect the confidentiality, integrity and availability (including the use of contingency 

plans) of any electronic protected health information (“EPHI”) it creates, receives, maintains or 

transmits from, or on behalf of the Covered Entity to prevent impermissible use, disclosure, 

maintenance or transmission of such EPHI. In the establishment of such safeguards, Business 

Associate shall consider its size, complexity and capabilities, as well as its technical infrastructure, and 

its hardware and software security capabilities.

iii. Assess, and implement, where appropriate, any addressable implementation specifications associated with 

applicable PHI security standards.

iv. Mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or 

disclosure of PHI by Business Associate in violation of the requirements of this Contract.

v. Comply with the following Incident Reporting:

A. Report to Covered Entity any security incident/breach involving unsecured PHI, of which it becomes 

aware, including those of its agents and subcontractors. The Business Associate shall report any 

violation of the terms of this contract involving PHI and any security incidents/breaches involving 

unsecured PHI to CMS within one (1) hour of discovery in accordance with the CMS Risk 

Management Handbook (RMH), specifically “RMH Vol II Procedure 7-2 Incident Handling 

Procedure” and “RMH Vol III Standard 7-1 Incident Handling.” These procedures can be found at 

http://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-InformationTechnology/InformationSecurity/Information-Security-Library.html. In addition, the Business 

Associate will also notify the CMS Contracting Officer and the Contracting Officer’s Representative 

(COR) by e-mail within one (1) hour of identifying such violation or incident.

B. Upon Covered Entity's knowledge of any material security incident/breach by Business Associate, 

Covered Entity will provide an opportunity for Business Associate to cure the breach or end the 

violation consistent with the termination clause of this Contract. See also paragraph D. Term of Clause 

below.

vi. Ensure that any agent or subcontractor agrees through a written contract, or other legally enforceable 

arrangement, to the same restrictions and conditions that apply through this HIPAA Contract Clause, when 

creating, receiving, maintaining or transmitting PHI from, or on behalf of, Covered Entity.

vii. Upon Covered Entity’s request:

A. Provide the Covered Entity or its designee with access to the PHI created, received, maintained or 

transmitted by Business Associate from or on behalf of the Covered Entity in the course of contract 

performance in order to ensure Covered Entity’s ability to meet the requirements under 45 CFR § 

164.524.

B. Amend PHI as Covered Entity directs or agrees to pursuant to 45 CFR §164.526.

viii. Make its facilities and any books, records, accounts, and any sources of PHI, including any policies and 

procedures, that are pertinent to ascertaining its own compliance with this contract or the Covered Entity’s 

compliance with the applicable HIPAA requirements, available to Covered Entity, or, in the context of an 

investigation or compliance review, to the Secretary for purposes of the Secretary determining Covered 

Entity's compliance with the various rules implementing the HIPAA.
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ix. Document disclosures of PHI and information related to such disclosures as would be required for Covered 

Entity to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 

45 CFR § 164.528.

x. Provide to Covered Entity, or an individual identified by the Covered Entity, information collected under 

this Contract, to permit Covered Entity to respond to a request by an Individual for an accounting of 

disclosures of PHI in accordance with 45 CFR § 164.528.

xi. Make reasonable efforts to limit the PHI it uses, discloses or requests to the minimum necessary to 

accomplish the intended purpose of the permitted use, disclosure or request.

c. Obligations of Covered Entity

Covered Entity shall notify Business Associate of any:

1. Limitation(s) in its Notice of Privacy Practices in accordance with 45 CFR § 164.520, to the extent that such 

limitation may affect Business Associate's use or disclosure of PHI;

2. Changes in, or revocation of, permission by an Individual to use or disclose their PHI, to the extent that such 

changes may affect Business Associate’s use or disclosure of PHI; and,

3. Restriction to the use or disclosure of PHI that Covered Entity has agreed to in accordance with 45 CFR § 

164.522, to the extent that such restriction may affect Business Associate’s use or disclosure of PHI.

d. Term of Clause

1. The term of this Clause shall be effective as of date of Contract award, and shall terminate when all of the PHI 

provided to Business Associate by the Covered Entity or a Business Associate of the Covered Entity, or created 

or received by Business Associate on behalf of Covered Entity, is destroyed or returned to Covered Entity in

accordance with “CMS Information Security” procedures. Business Associate shall not retain any PHI.

2. Security Incident/Breach:

Upon Covered Entity’s knowledge of a material breach by Business Associate, Covered Entity shall take action 

consistent with the terms of this Contract, and, as appropriate, the following:

i. Federal Acquisition Regulation (FAR) Contracts – Covered Entity may:

A. Terminate this Contract in accordance with FAR Part 49, Termination of Contracts, if the Business 

Associate does not cure the security incident/breach within the time specified by Covered Entity and/or 

cure is not possible; or,

B. If neither termination nor cure is feasible, Covered Entity shall report the violation to the Secretary.

ii. Other Agreements –Covered Entity shall either:

A. Provide an opportunity for Business Associate to cure the breach or end the violation consistent with 

the termination terms of this Contract. Covered Entity may terminate this Contract for default if the 

Business Associate does not cure the breach or end the violation within the time specified by Covered 

Entity; or,

B. Consistent with the terms of this Contract, terminate this Contract for default if Business Associate has 

breached a material term of this Contract and cure is not possible; or,

C. If neither termination nor cure is feasible, Covered Entity shall report the violation to the Secretary.

3. Returning or Destroying PHI:

Business Associate, as defined above, which includes subcontractors or agents of the Contractor, shall:

i. Upon expiration or termination of this Contract, for any reason, return or destroy all PHI received from 

Covered Entity or another Business Associate of the Covered Entity, as well as any PHI created, received, 

maintained or transmitted from or on behalf of Covered Entity, or another Business Associate of the 

Covered Entity, in accordance with this contract, including the “CMS Information Security” clause.
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ii. In the event that Business Associate determines that returning or destroying the PHI is infeasible, provide 

to Covered Entity notification of the conditions that make return or destruction infeasible. Upon such 

notice that return or destruction of PHI is infeasible, Business Associate shall extend the protections of this 

Contract to such PHI and limit further uses and disclosures of such PHI to those purposes that make the 

return or destruction infeasible, for so long as Business Associate maintains such PHI.

e. Miscellaneous

1. A reference in this Contract to a section in the Rules issued under HIPAA means the section as in effect or as 

amended.

2. The respective rights and obligations of Business Associate under paragraph D.3.b of the section entitled “Term 

of Clause” shall survive the termination of this Contract.

Any ambiguity in this Contract clause shall be resolved to permit Covered Entity to comply with the Rules implemented 

under HIPAA.
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CMS SPECIFIC PROVISIONS FOR HIGH VISIBILITY/HIGH PUBLIC INTEREST CONTRACTS (OCT 2013) 

OPEN GOVERNMENT PROACTIVE PREDISCLOSURE NOTIFICATION (OCT 2013)

In order to reduce the administrative burden of responding to Freedom of Information Act (FOIA) requests for high 

visibility/high public interest contracts throughout contract administration, the Contractor shall submit its review of the 

awarded contract (and contract modifications, if requested) for FOIA disclosure exemptions within thirty (30) calendar days 

of contract award. The review will substantiate “...Trade secrets and commercial or financial information obtained from a 

person and privileged or confidential...” information, in accordance with 5 U.S.C. §552 FOIA, Exemption (b)(4), which 

could reasonably be expected to cause substantial competitive harm.

Submissions: The Contractor shall submit one (1) Compact Disc (CD) or Digital Video Disc (DVD) with all 5 U.S.C. §552 

FOIA, Exemption (b)(4), “...Trade Secrets, Commercial or Financial Information Which is Privileged or Confidential...,” 

otherwise known as public release/non-Confidential Business Information (non-CBI), with the information identified as 

follows: 

a. CBI Highlighted Copy of Contract: One copy of the contract with all CBI highlighted for CMS FOIA review.

b. Contractor Proposed Redacted Public Release Copy of Contract: An additional copy of the contract will be 

provided for public release with all the identified information redacted. Redactions shall be made using “black” 

boxes, which cannot be removed or uncovered by a reader.

c. Pre-Disclosure Concerns - Comments/Rationale for Non-Disclosure of Trade Secrets, Commercial or 

Financial Information Which is Privileged or Confidential: The Contractor shall provide, in a separate file, 

rationale for why disclosure of “...Trade Secrets, Commercial or Financial Information Which is Privileged or 

Confidential...” would cause the Contractor organization substantial competitive harm if disclosed to other entities. 

Rationale shall be provided for each individual recommended redaction. Generalized conclusions of competitive 

harm are not a sufficient basis for the CMS FOIA office to invoke the exemption and thereby protect the 

Contractor’s interest.

All CD/DVDs shall be mailed to the CMS FOIA Officer (address below) within thirty (30) calendar days of contract award 

and within thirty (30) calendar days of a CMS request, i.e. existing or modified contracts. All CD/DVD files shall be 

submitted as Portable Document Format (.pdf) files. 

CD/DVD and File Naming Conventions: The Contractor shall name the CD/DVD with the Contract Number and utilize 

the following CD/DVD file naming conventions:

• HHSM-500-2013-xxxxxx – Highlighted • HHSM-500-2013-xxxxxx – Redacted • HHSM-500-2013-xxxxxx – Pre-Disclosure Concerns

CD/DVD shall be mailed to the CMS FOIA Officer at:

Centers for Medicare & Medicaid Services

Freedom of Information Act Office

ATTN: CMS FOIA Officer

Mailstop: N2-20-16

7500 Security Boulevard

Baltimore, MD 21244-1850

Copy Correspondence Only (No CD/DVD):

Contracting Officer

Contracting Officer’s Representative (COR)

It should be noted that the CMS FOIA Office makes the final determination as to what information is released to the public, 

after considering any feedback from OAGM and/or the Contractor.
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CMS SECURITY CLAUSE 

FAR 52.204-9 Personal Identity Verification of Contractor Personnel.

As prescribed in 4.1303, insert the following clause:

PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL (JAN 2011)

(a) The Contractor shall comply with agency personal identity verification procedures identified in the contract that 

implement Homeland Security Presidential Directive-12 (HSPD-12), Office of Management and Budget (OMB) 

guidance M-05-24 and Federal Information Processing Standards Publication (FIPS PUB) Number 201.

(b) The Contractor shall account for all forms of Government-provided identification issued to the Contractor 

employees in connection with performance under this contract. The Contractor shall return such identification to the 

issuing agency at the earliest of any of the following, unless otherwise determined by the Government:

(1) When no longer needed for contract performance.

(2) Upon completion of the Contractor employee’s employment.

(3) Upon contract completion or termination.

(c) The Contracting Officer may delay final payment under a contract if the Contractor fails to comply with these 

requirements.

(d) The Contractor shall insert the substance of this clause, including this paragraph (d), in all subcontracts when the 

subcontractor’s employees are required to have routine physical access to a Federally-controlled facility and/or 

routine access to a Federally-controlled information system. It shall be the responsibility of the prime Contractor to 

return such identification to the issuing agency in accordance with the terms set forth in paragraph (b) of this 

section, unless otherwise approved in writing by the Contracting Officer.

(End of clause)

FAR 52.222-54 Employment Eligibility Verification.

As prescribed in 22.1803, Insert the following clause:

EMPLOYMENT ELIGIBILITY VERIFICATION (OCT 2015)

(a) Definitions. As used in this clause— 

“Commercially available off-the-shelf (COTS) item”— 

(1) Means any item of supply that is— 

(i) A commercial item (as defined in paragraph (1) of the definition at 2.101);

(ii) Sold in substantial quantities in the commercial marketplace; and

(iii) Offered to the Government, without modification, in the same form in which it is sold in the commercial 

marketplace; and

(2) Does not include bulk cargo, as defined in 46 U.S.C. 40102 (4), such as agricultural products and petroleum 

products. Per 46 CFR 525.1 (c) (2), “bulk cargo” means cargo that is loaded and carried in bulk onboard ship 

without mark or count, in a loose unpackaged form, having homogenous characteristics. Bulk cargo loaded into 

intermodal equipment, except LASH or Seabee barges, is subject to mark and count and, therefore, ceases to be 

bulk cargo.
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“Employee assigned to the contract” means an employee who was hired after November 6, 1986 (after November 

27, 2009 in the Commonwealth of the Northern Mariana Islands), who is directly performing work, in the United 

States, under a contract that is required to include the clause prescribed at 22.1803. An employee is not considered 

to be directly performing work under a contract if the employee— 

(1) Normally performs support work, such as indirect or overhead functions; and

(2) Does not perform any substantial duties applicable to the contract.

“Subcontract” means any contract, as defined in 2.101, entered into by a subcontractor to furnish supplies or 

services for performance of a prime contract or a subcontract. It includes but is not limited to purchase orders, and 

changes and modifications to purchase orders.

“Subcontractor” means any supplier, distributor, vendor, or firm that furnishes supplies or services to or for a prime 

Contractor or another subcontractor.

“United States”, as defined in 8 U.S.C. 1101 (a) (38), means the 50 States, the District of Columbia, Puerto Rico, 

Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands.

(b) Enrollment and verification requirements.

(1) If the Contractor is not enrolled as a Federal Contractor in E-Verify at time of contract award, the Contractor 

shall— 

(i) Enroll. Enroll as a Federal Contractor in the E-Verify program within 30 calendar days of contract award;

(ii) Verify all new employees. Within 90 calendar days of enrollment in the E-Verify program, begin to use E- Verify to initiate verification of employment eligibility of all new hires of the Contractor, who are working 

in the United States, whether or not assigned to the contract, within 3 business days after the date of hire 

(but see paragraph (b) (3) of this section); and

(iii) Verify employees assigned to the contract. For each employee assigned to the contract, initiate verification 

within 90 calendar days after date of enrollment or within 30 calendar days of the employee’s assignment 

to the contract, whichever date is later (but see paragraph (b) (4) of this section).

(2) If the Contractor is enrolled as a Federal Contractor in E-Verify at time of contract award, the Contractor shall 

use E-Verify to initiate verification of employment eligibility of— 

(i) All new employees. 

(A) Enrolled 90 calendar days or more. The Contractor shall initiate verification of all new hires of the 

Contractor, who are working in the United States, whether or not assigned to the contract, within 3 

business days after the date of hire (but see paragraph (b) (3) of this section); or

(B) Enrolled less than 90 calendar days. Within 90 calendar days after enrollment as a Federal Contractor 

in E-Verify, the Contractor shall initiate verification of all new hires of the Contractor, who are 

working in the United States, whether or not assigned to the contract, within 3 business days after the 

date of hire (but see paragraph (b) (3) of this section); or 

(ii) Employees assigned to the contract. For each employee assigned to the contract, the Contractor shall 

initiate verification within 90 calendar days after date of contract award or within 30 days after assignment 

to the contract, whichever date is later (but see paragraph (b) (4) of this section).

(3) If the Contractor is an institution of higher education (as defined at 20 U.S.C. 1001 (a)); a State or local 

government or the government of a Federally recognized Indian tribe; or a surety performing under a takeover 

agreement entered into with a Federal agency pursuant to a performance bond, the Contractor may choose to 

verify only employees assigned to the contract, whether existing employees or new hires. The Contractor shall 

follow the applicable verification requirements at (b) (1) or (b) (2) respectively, except that any requirement for 

verification of new employees applies only to new employees assigned to the contract.
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(4) Option to verify employment eligibility of all employees. The Contractor may elect to verify all existing 

employees hired after November 6, 1986 (after November 27, 2009, in the Commonwealth of the Northern 

Mariana Islands), rather than just those employees assigned to the contract. The Contractor shall initiate 

verification for each existing employee working in the United States who was hired after November 6, 1986 

(after November 27, 2009, in the Commonwealth of the Northern Mariana Islands), within 180 calendar days 

of— 

(i) Enrollment in the E-Verify program; or

(ii) Notification to E-Verify Operations of the Contractor’s decision to exercise this option, using the contact 

information provided in the E-Verify program Memorandum of Understanding (MOU).

(5) The Contractor shall comply, for the period of performance of this contract, with the requirements of the EVerify program MOU. 

(i) The Department of Homeland Security (DHS) or the Social Security Administration (SSA) may terminate 

the Contractor’s MOU and deny access to the E-Verify system in accordance with the terms of the MOU. 

In such case, the Contractor will be referred to a suspension or debarment official.

(ii) During the period between termination of the MOU and a decision by the suspension or debarment official 

whether to suspend or debar, the Contractor is excused from its obligations under paragraph (b) of this 

clause. If the suspension or debarment official determines not to suspend or debar the Contractor, then the 

Contractor must reenroll in E-Verify.

(c) Web site. Information on registration for and use of the E-Verify program can be obtained via the Internet at the 

Department of Homeland Security Web site: http://www.dhs.gov/E-Verify. 

(d) Individuals previously verified. The Contractor is not required by this clause to perform additional employment 

verification using E-Verify for any employee— 

(1) Whose employment eligibility was previously verified by the Contractor through the E-Verify program;

(2) Who has been granted and holds an active U.S. Government security clearance for access to confidential, secret, 

or top secret information in accordance with the National Industrial Security Program Operating Manual; or

(3) Who has undergone a completed background investigation and been issued credentials pursuant to Homeland 

Security Presidential Directive (HSPD)-12, Policy for a Common Identification Standard for Federal 

Employees and Contractors.

(e) Subcontracts. The Contractor shall include the requirements of this clause, including this paragraph (e) 

(appropriately modified for identification of the parties), in each subcontract that— 

(1) Is for— 

(i) Commercial or noncommercial services (except for commercial services that are part of the purchase of a 

COTS item (or an item that would be a COTS item, but for minor modifications), performed by the COTS 

provider, and are normally provided for that COTS item); or

(ii) Construction;

(2) Has a value of more than $3,500; and

(3) Includes work performed in the United States.

(End of clause)
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CMS SECURITY CLAUSE (APR 2016) 

a. Applicability

In accordance with OMB Memorandum M-05-24, Implementation of Homeland Security Presidential Directive 12 

(HSPD-12): Policy for a Common Identification Standard for Federal Employees and Contractors, dated August 

27, 2004, and Federal Information Processing Standard (FIPS) PUB Number 201-2, Personal Identity Verification 

(PIV) of Federal Employees and Contractors, CMS must achieve appropriate security assurance for multiple 

applications by efficiently verifying the claimed identity of individuals seeking physical access to Federally 

controlled government facilities and/or logical access to federally controlled information systems. Contractors that 

require routine physical access to a CMS facility and/or routine access to a CMS federally controlled information 

system will be required to obtain a CMS issued PIV, PIV-I or Locally Based Physical Access card. FIPS PUB 

201-2 specifies the architecture and technical requirements for a common identification standard for Federal 

employees and Contractors.

When a PIV or PIV-I card is provided, it shall be used in conjunction with a compliant card reader and middleware 

for logical system access. The Contractor shall (1) Include FIPS 201-2 compliant, HSPD-12 card readers with the 

purchase of servers, desktops, and laptops; and (2) comply with FAR 52.204-9, Personal Identity Verification of 

Contractor Personnel.

b. Definitions

“Agency Access” means access to CMS facilities, sensitive information, information systems or other CMS 

resources.

“Applicant” is a Contractor employee for whom the Contractor submits an application for a CMS identification card.

“Contractor Employee” means prime Contractor and subcontractor employees who require agency access to perform 

work under a CMS contract.

“Official station”— As defined by Federal Travel Regulations, an area defined by the agency that includes the 

location where the employee regularly performs his or her duties or an invitational traveler’s home or regular place 

of business. The area may be a mileage radius around a particular point, a geographic boundary, or any other 

definite domain, provided no part of the area is more than 50 miles from where the employee regularly performs his 

or her duties or from an invitational traveler’s home or regular place of business. If the employee’s work involves 

recurring travel or varies on a recurring basis, the location where the work activities of the employee’s position of 

record are based is considered the regular place of work.

“Federal Identification Card” (or “ID card”) means a federal government issued or accepted identification card such 

as a Personal Identity Verification (PIV) card, Personal Identity Verification-Interoperable (PIV-I) card, or a Local- Based Physical Access Card issued by CMS, or a Local-Based Physical Access Card issued by another Federal 

agency and approved by CMS. “Issuing Office” means the CMS entity that issues identification cards to Contractor 

employees.

“Locally Based Physical Access Card” means an access Card that is graphically personalized for visual

identification, that does not contain an embedded computer chip, and is only used for physical access.

“Local Security Servicing Organization” means the CMS entity that provides security services to the CMS 

organization sponsoring the contract, Division of Physical Security and Strategic Information (DPSSI).

“Logical Access” means the ability for the Contractor to interact with CMS information systems, databases, digital 

infrastructure, or data via access control procedures such as identification, authentication, and authorization.

“Personal Identity Verification (PIV) card,” as defined in FIPS PUB 201-2, is a physical artifact (e.g., identity card, 

“smart” card) issued to an individual that contains a PIV Card Application which stores identity credentials (e.g., 

photograph, cryptographic keys, digitized fingerprint representation) so that the claimed identity of the cardholder 

can be verified against the stored credentials by another person (human readable and verifiable) or an automated 

process (computer readable and verifiable).
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3561-S (01/25)

“Personal Identity Verification-Interoperable (PIV-I) card” similar to a PIV card, is a physical artifact (e.g., identity 

card, “smart” card) issued to an individual that contains a PIV Card Application which stores identity credentials 

(e.g., photograph, cryptographic keys, digitized fingerprint representation) so that the claimed identity of the 

cardholder can be verified against the stored credentials by another person (human readable and verifiable) or an 

automated process (computer readable and verifiable). PIV-I cards are issued by a non-federal government entity to 

non-federal government staff. PIV-I cards are issued in a manner that allows federal relying parties to trust the cards. 

The PIV-I cards uses the same standards of vetting and issuance developed by the U.S. government for its 

employees

c. Screening of Contractor Employees

i. Contractor Screening of Applicants

1. Contractor Responsibility: The Contractor shall pre-screen individuals designated for employment under 

any CMS contract by verifying minimum suitability requirements to ensure that only qualified candidates 

are considered for contract employment. At the discretion of the government, the government reserves the 

right to request and/or review Contractor employee vetting processes. The federal minimum suitability 

requirements can be found below in section (c) (2)—Suitability Requirements, and are also contained in 5 

CFR 731.202. The Contractor shall exercise due diligence in pre-screening all employees prior to 

submission to CMS for agency access.

2. Alien Status: The Contractor shall monitor an alien’s (foreign nationals) continued authorization for 

employment in the United States. If requested by the Agency, the Contractor shall provide documentation 

to the Contracting Officer (CO) or the Contracting Officer’s Representative (COR) that validates that the 

Employment Eligibility Verification (e-Verify) requirement has been met for each Contractor or subContractor employee working on the contract in accordance with Federal Acquisition Regulation (FAR) 

52.222-54 – Employment Eligibility Verification.

3. Residency Requirement: All CMS Contractor applicants shall have lived in the United States at least three 

(3) out of the last five (5) years prior to submitting an application for a Federal ID Card. CMS will process 

background investigations for foreign nationals in accordance with Office of Personnel Management 

(OPM) guidance. Contractor employees who worked for the U.S. Government as an employee overseas in 

a Federal or military capacity; and/or been a dependent of a U.S. Federal or military employee serving 

overseas, must be able to provide state-side reference coverage. State-side coverage information is 

required to make a suitability or security determination. Examples of state-side coverage information 

include: the state-side address of the company headquarters where the applicant’s personnel file is located, 

the state-side address of the Professor in charge of the applicant’s “Study Abroad” program, the religious 

organization, charity, educational, or other non-profit organization records for the applicant’s overseas 

missions, and/or the state-side addresses of anyone who worked or studied with the applicant while 

overseas.

4. Selective Service Registration: All males born after December 31, 1959, must meet the Federal Selective 

Service System requirements as established on www.sss.gov. 

ii. Identification Card Application Process

ID Card Sponsor: The CMS Contracting Officer’s Representative (COR) will be the CMS ID card Sponsor 

and point of contact for the Contractor’s application for a CMS ID card. The COR will review and 

approve/deny the HHS ID Badge Request before the form is submitted to the CMS, Office of Support Services 

and Operations, (OSSO), Division of Personnel Security Services (DPS), for processing. If approved, an 

applicant may be issued either a Personal Identity Verification (PIV) or PIV- I card that meets the standards of 

HSPD-12 or a Local-Based Physical Access Card.

Contractor Application Required Submissions: All applicants shall submit an HHS ID Badge Request form 

for issuance of a Federal ID Card. Unless otherwise directed by the ID Card Sponsor or DPS, applicants are 

required to electronically submit the request form via CMS’ Enterprise User Administration (EUA) Electronic 

Front-end Interface (EFI) system, which is located at https://eua.cms.gov/efi. To assist users with the 

application process, a user’s guide is located at: https://www.cms.gov/About-CMS/Contracting-WithCMS/ContractingGeneralInformation/Contracting-Policy-and-Resources.html.

The EUA users guide link should be used to obtain the most current instructional guidance.
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PIV Training: Contractors who need PIV or PIV-I card shall complete HHS PIV Applicant Training, which is 

found at https://www.cms.gov/About-CMS/Contracting-WithCMS/ContractingGeneralInformation/Contracting-Policy-and-Resources.html. A copy of the completion 

certificate shall be included with the EFI application.

CMS Applicant Evaluations: CMS will evaluate an applicant’s required access level. Once the review is 

complete and accepted for further processing, the applicant will be contacted by DPS to submit the below 

information, as applicable.

1. e-QIP: Contractor employees will be required to submit information into e-QIP, a web-based 

automated system that is designed to facilitate the processing of standard investigative forms used 

when conducting background investigations for Federal security, suitability, fitness and credentialing 

purposes.

2. Fingerprints: Instructions for obtaining fingerprints will be provided by CMS, OSSO, DPS.

3. OF 306: Contractor employees may be required to complete the Optional Form (OF) 306, Declaration 

for Federal Employment which can be found at https://www.opm.gov/forms/pdf_fill/of0306.PDF.

4. Access to Restricted Area(s): The CMS COR will initiate all Federal ID card holders’ physical 

access requests via Physical Access Control System (PACS) Central at https://pam.cms.local. 

Suitability Requirements: CMS may decline to grant agency access to a Contractor employee including, but 

not limited to, any of the criteria cited below:

1. Misconduct or negligence in employment;

2. Criminal or dishonest conduct;

3. Material, intentional false statement, or deception or fraud in examination or appointment;

4. Refusal to furnish testimony as required by § 5.4 of 5 CFR 731.202;

5. Alcohol abuse, without evidence of substantial rehabilitation, of a nature and duration that suggests 

that the applicant or appointee would be prevented from performing the duties of the position in 

question, or would constitute a direct threat to the property or safety of the applicant or appointee or 

others;

6. Illegal use of narcotics, drugs, or other controlled substances without evidence of substantial 

rehabilitation;

7. Knowing and willful engagement in acts or activities designed to overthrow the U.S. Government by 

force; and

8. Any statutory or regulatory bar which prevents the lawful employment of the person involved in the 

position in question.

Badge Issuance: Upon approval of the badging application process and prior to starting work on the contract, 

applicants whose official station is located within 50 miles from CMS’ central office or one of its regional 

offices will be contacted to appear in person, at least two times (estimated at one hour for each visit), and shall 

provide two (2) original forms of identity source documents in order to generate the badge/ID. The identity 

source documents shall come from the list of acceptable documents included in FIPS 201-2, located at 

http://nvlpubs.nist.gov/nistpubs/FIPS/NIST.FIPS.201-2.pdf. At least one (1) document shall be a valid State or 

Federal government-issued picture ID. PIV-I mobile enrollment stations will be made available for applicants 

that have an official station more than 50 miles from CMS or any of its regional offices, and the employee will 

not need to travel to a CMS Office. The Contractor will be contacted by CMS for further instructions on the 

badging process in this scenario.

d. CMS Position Designation Assessment

CMS will assign a risk and sensitivity level designation analysis to the overall contract and/or to Contractor 

employee positions by category, group or individual. The risk and sensitivity level designations will be the basis for 

determining the level and type of personnel security investigations required for Contractor employees. At a 

minimum, the FBI National Criminal History Check (fingerprint check) must be favorably adjudicated. 

Additionally, the OPM e-QIP and other required forms must be accepted by DPS before a CMS identification card 

will be issued.

e. Post Badging Training Requirements:

Contractor employees that receive an HHS ID Badge are expected to complete the following online trainings each 

year, according to the timeframes indicated below, and annually thereafter. The below list is not all inclusive and 

the COR may indicate training that must be taken in addition to the below:
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i. Security and Insider Threat Awareness and Training (30 days after receiving badge): This course outlines 

the role of Contractors with regard to protecting information and ensuring the secure operation of CMS 

federally controlled information systems. Estimated time to complete is one hour.

ii. Computer Based Training (CBT) (within 3 days of approved EUA account): This training offers several 

modules to familiarize contractor employees with features of CMS’ webinar service. Estimated time to 

complete is one hour.

f. Background Investigation and Adjudication

Upon contract award and receipt of an HHS ID Badge Request, CMS will initiate the Agency Access procedures, to 

include a background investigation.

CMS may accept favorable background investigation adjudications from other Federal agencies when there has been 

no break in service. A favorable adjudication does not preclude CMS from initiating a new investigation when 

deemed necessary. Each CMS sponsored Contractor shall use the OPM e-QIP system to complete any required 

investigative forms.

The Contractor remains fully responsible for ensuring contract performance pending completion of background 

investigations of Contractor personnel. Employees that do not require access to CMS federally controlled 

information systems, facilities, or sensitive information in order to perform their duties may begin work on a 

contract immediately and need not submit an HHS ID Badge Request.

i. Failure to cooperate with OPM or Agency representatives during the background investigation process is 

considered grounds for removal from the contract.

ii. DPS may provide written notification to the Contractor employee, with a copy to the COR, of all 

suitability/non-suitability decisions. A CMS adjudicative decision (based on criminal history results or 

completed investigation results) is final, and is not subject to appeal.

iii. Contractor personnel for whom DPS determines to be ineligible for ID issuance will be required to cease 

working on the contract immediately.

iv. The Contractor shall immediately submit an adverse information report, in writing to the CO with a copy to the 

COR, of any adverse information regarding any of its employees that may impact their ability to perform under 

this contract. Reports should be based on reliable and substantiated information, not on rumor or innuendo. 

The report shall include, at a minimum, the Contractor employee’s name and associated contract number along 

with the adverse information. The COR will forward the adverse information report to the DPS for review 

and/or action.

v. At the Agency’s discretion, Contractor personnel may be provided an opportunity to explain or refute 

unfavorable information before an adjudicative decision is rendered on whether or not to withdraw the Federal 

ID from the individual in question. Under the provision of the Privacy Act of 1974, Contractor personnel may 

request a copy of their own investigation by submitting a written request to the OPM Federal Investigative 

Services (FIS) Freedom of Information (FOI) office. The following OPM-FOI link is being provided to afford 

one the instructions for obtaining a copy of one’s file: https://www.opm.gov/investigations/freedom-of- information-and-privacy-act-requests/. 

g. Background Investigation Cost

The government will bear the cost of background investigations that are performed at the direction of CMS’ 

personnel security representatives by the Federal government’s approved and designated background investigation 

service provider, the OPM.

At the Agency’s discretion, if an investigated Contractor employee leaves the employment of the Contractor, or 

otherwise is no longer associated with the contract within one (1) year from the date the background investigation 

was completed, the Contractor may be required to reimburse CMS for the full cost of the investigation. Depending 

upon the type of background investigation conducted and the cost incurred by CMS, the Contractor cost will be 

determined based upon the current OPM fiscal year billing rates, which can be found at 

http://www.opm.gov/investigations/background-investigations/federal-investigations-notices. The amount to be 

paid by the Contractor shall be due and payable when the CO submits a written letter notifying the Contractor as to 

the cost of the investigation. The Contractor shall pay the amount due within thirty (30) days of the date of the CO’s 

letter by check, made payable to the “United States Treasury.” The Contractor shall provide a copy of the CO’s 

letter as an attachment to the check and submit both to the Office of Financial Management at the following address:

Centers for Medicare & Medicaid Services

PO Box 7520

Baltimore, Maryland 21207
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h. Identification Card Custody and Control

The Contractor is responsible for the custody and control of all forms of Federal identification issued by CMS to 

Contractor employees. The Contractor shall immediately notify the COR when a Contractor employee no longer 

requires agency access due to transfer, completion of a project, retirement, removal from work on the contract, or 

termination of employment. Return all CMS Federal ID cards to:

The Centers for Medicare and Medicaid Services

Attn: DPS, Mailstop: SL-17-06

7500 Security Boulevard

Baltimore, Maryland 21244

The Contractor shall also ensure that Contractor employees comply with CMS requirements concerning the renewal, 

loss, theft, or damage of an ID card.

Failure to comply with the requirements for custody and control of CMS issued ID cards may result in a delay in 

withholding final payment or contract termination, based on the potential for serious harm caused by inappropriate 

access to CMS facilities, sensitive information, information systems or other CMS resources.

i. Renewal: A Contractor employee’s CMS issued ID card is valid for a maximum of five (5) years and 9 months 

or until the contract expiration date (including option periods), whichever occurs first. The renewal process 

should begin six weeks before the ID card expiration date by contacting the COR. If an ID card is not renewed 

before it expires, the Contractor employee will be required to sign-in daily for facility access and may have 

limited access to information systems and other resources. Contractor ID card certificate(s) require yearly 

updates from the issuance date. The yearly updates should be coordinated between the contractor and the COR.

ii. Lost/Stolen: Immediately upon detection that an ID card is lost or stolen, the Contractor or Contractor employee 

shall report a lost or stolen ID card to the COR and the local security servicing organization at

SECURITY@cms.hhs.gov. The Contractor shall also submit an Incident Report within 48 hours, to the COR, 

DPS at Badging@cms.hhs.gov, and the local security servicing organization. The Incident Report shall 

describe the circumstances of the loss or theft. If the loss or theft is reported by the Contractor to the local 

police, a copy of the police report shall be provided to the COR. The Contractor employee shall sign in daily 

for facility access and may have limited access to information systems and other resources until the replacement 

card is issued.

iii. Replacement: An ID card will be replaced if it is damaged, contains incorrect data, or is lost or stolen for more 

than three (3) days, provided there is a continuing need for agency access to perform work under the contract.

In the event that the PIV card or certificate(s) are not renewed in a timely fashion, or the ID card requires 

replacement due to being lost, stolen, or damaged, the contractor employee will go through the “Badge Issuance” 

process again as described in above in section (c) (2). In any of these events, contact your COR to coordinate the 

appropriate next steps.

i. Surrender ID Cards/Access Cards, Government Equipment

CMS reserves the right to suspend or withdraw ID card access at any time for any reason. Access will be restored 

upon the resolution of the issue(s).

Upon notification that routine access to CMS facilities, sensitive information, federally controlled information 

systems or other CMS resources is no longer required, the Contractor shall surrender the CMS issued ID card, 

access card, keys, computer equipment, and other government property to the CMS COR or directly to CMS at the 

address referenced above in section (f). DPS Contractor personnel who do not return their government issued 

property within 48 hours of the last day of authorized access to CMS, may be permanently barred from CMS 

systems and facilities and may be subject to fines and penalties, as authorized by applicable Federal or State laws. 
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EXHIBITS 

EXHIBIT A: MEDICARE PREMIUM BILL FILE LAYOUT FOR CMS-500, CMS-500ID, CMS-20143, AND CMS20143ID FORMS 

TABLE 1: CMS-500/CMS-500ID/CMS-20143/CMS-20143ID REVISED FILE LAYOUT 

Field 

# Field Name Format

Start 

Position End Position Remarks

1 Medicare 

Beneficiary 

Identifier

X(11) 1 11 Alpha Numeric

Unique Medicare 

Beneficiary 

Identifier

2 Servicing 

Program 

Service Center

X(1) 12 12 Values 1 through 8

3 Surname X(3) 13 15 First Three Letters 

of Surname

4 ZIP Code 9(5) 16 20 Numeric

5 Extended ZIP 

Code

X(4) 21 24 Blank or Alpha 

Numeric

6 Address Line 1 X(22) 25 46 Beneficiary Name 

(Note: Last 

address line field 

contains the Zone 

Improvement Plan 

(ZIP) Code.)

7 Address Line 2 X(22) 47 68 None

8 Address Line 3 X(22) 69 90 None

9 Address Line 4 X(22) 91 112 None

10 Address Line 5 X(22) 113 134 None

11 Address Line 6 X(22) 135 156 None

12 Statement Date 9(8) 157 164 MMDDYYYY, 

Actual Bill run date

13 Bill Due Date 9(8) 165 172 MMDDYYYY, 25th

of the month after 

Statement Date
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Field 

# Field Name Format

Start 

Position End Position Remarks

14 Current Start 

Date 

9(8) 173 180 MMDDYYYY 

(Hospital 

Insurance/Part A, 

Medical 

Insurance/Part B & 

Part B IRMAA, Part 

D IRMAA, Part B 

Immunosuppressive 

Drug (PBID), Part B 

Immunosuppressive 

Drug IRMAA (PBID 

IRMAA)) 

15 Current Through 

Date

9(8) 181 188 MMDDYYYY 

(Hospital 

Insurance/Part A, 

Medical 

Insurance/Part B & 

Part B IRMAA, Part 

D IRMAA, Part B 

Immunosuppressive 

Drug (PBID), Part B 

Immunosuppressive 

Drug IRMAA (PBID 

IRMAA)) 

16 Current Amount 

– Part A

9(8) 189 196 $$$$$$cc 

(Hospital 

Insurance/Part A)

17 Current Amount 

– Part B or 

Current Amount 

– Part B 

Immuno Drug

9(8) 197 204 $$$$$$cc 

(Medical 

Insurance/Part B

or Part B 

Immunosuppressive 

Drug (PBID))

18 Current Amount 

– Part B IRMAA 

or Current 

Amount – Part B 

Immuno Drug 

IRMAA

9(8) 205 212 $$$$$$cc 

(Medical 

Insurance/Part B 

IRMAA)

or (Part B 

Immunosuppressive 

Drug IRMAA (PBID 

IRMAA)) 
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3561-S (01/25)

Field 

# Field Name Format

Start 

Position End Position Remarks

19 Current Amount 

– Part D IRMAA

9(8) 213 220 $$$$$$cc 

(Part D IRMAA)

20 Total Current 

Amount – Part 

A, Part B, Part B 

IRMAA, Part D 

IRMAA, or Part 

B Immuno Drug, 

Part B Immuno 

Drug IRMAA

9(8) 221 228 $$$$$$cc 

(Hospital 

Insurance/Part A, 

Medical 

Insurance/Part B & 

Part B IRMAA, Part 

D IRMAA) or (Part 

B 

Immunosuppressive 

Drug (PBID), Part B 

Immunosuppressive 

Drug IRMAA (PBID 

IRMAA)) 

21 Past Due Start 

Date 

9(8) 229 236 MMDDYYYY 

(Hospital 

Insurance/Part A, 

Medical 

Insurance/Part B & 

Part B IRMAA, Part 

D IRMAA, Part B 

Immunosuppressive 

Drug (PBID), Part B 

Immunosuppressive 

Drug IRMAA (PBID 

IRMAA)) 

Note: zeroes if not 

applicable, does not 

apply for Easy Pay 

notice/will default to 

zeroes
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Field 

# Field Name Format

Start 

Position End Position Remarks

22 Past Due 

Through Date

9(8) 237 244 MMDDYYYY 

(Hospital 

Insurance/Part A, 

Medical 

Insurance/Part B & 

Part B IRMAA, Part 

D IRMAA, Part B 

Immunosuppressive 

Drug (PBID), Part B 

Immunosuppressive 

Drug IRMAA (PBID 

IRMAA)) 

Note: zeroes if not 

applicable, does not 

apply for Easy Pay 

notice/will default to 

zeroes

23 Part Due 

Amount – Part A

9(8) 245 252 $$$$$$cc 

(Hospital 

Insurance/Part A)

Note: zeroes if not 

applicable, does not 

apply for Easy Pay 

notice/will default to 

zeroes

24 Past Due 

Amount – Part B 

or Past Due 

Amount – Part B

Immuno Drug

9(8) 253 260 $$$$$$cc 

(Medical 

Insurance/Part B) or 

(Part B 

Immunosuppressive 

Drug (PBID))

Note: zeroes if not 

applicable, does not 

apply for Easy Pay 

notice/will default to 

zeroes
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Field 

# Field Name Format

Start 

Position End Position Remarks

25 Past Due 

Amount – Part B 

IRMAA or Past 

Due Amount – 

Part B Immuno 

Drug IRMAA

9(8) 261 268 $$$$$$cc 

(Medical 

Insurance/Part B 

IRMAA) or (Part B 

Immunosuppressive 

Drug IRMAA (PBID 

IRMAA)) 

Note: zeroes if not 

applicable, does not 

apply for Easy Pay 

notice/will default to 

zeroes

26 Past Due 

Amount – Part D 

IRMAA

9(8) 269 276 $$$$$$cc 

(Part D IRMAA) 

Note: zeroes if not 

applicable, does not 

apply for Easy Pay 

notice/will default to 

zeroes

27 Total Past Due 

Amount – Part 

A, Part B, Part B 

IRMAA, or Part 

D IRMAA, Part 

B Immuno Drug, 

Part B Immuno 

Drug IRMAA

9(8) 277 284 $$$$$$cc 

(Hospital 

Insurance/Part A, 

Medical 

Insurance/Part B & 

Part B IRMAA, Part 

D IRMAA, or (Part 

B 

Immunosuppressive 

Drug (PBID), Part B 

Immunosuppressive 

Drug IRMAA (PBID 

IRMAA)) 

Note: zeroes if not 

applicable, does not 

apply for Easy Pay 

notice/will default to 

zeroes

28 Total Amount 

Due

9(8) 285 292 $$$$$$cc

Total Current 

Amount + Total 

Past Due Amount
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3561-S (01/25)

Field 

# Field Name Format

Start 

Position End Position Remarks

29 Termination 

Date – Part A

9(8) 293 300 MMDDYYYY 

(Hospital 

Insurance/Part A)

Note: zeroes if not 

applicable, does not 

apply for Easy Pay 

notice/will default to 

zeroes

30 Termination 

Date – Part 

B/Part B IRMAA 

or Termination 

Date – Part B 

Immuno Drug

9(8) 301 308 MMDDYYYY 

(Medical 

Insurance/Part B & 

Part B IRMAA or 

(Part B 

Immunosuppressive 

Drug & Part B 

Immunosuppressive 

Drug IRMAA))

Note: zeroes if not 

applicable, does not 

apply for Easy Pay 

notice/will default to 

zeroes

31 Termination 

Date – Part D 

IRMAA

9(8) 309 316 MMDDYYYY 

(Part D IRMAA)

Note: zeroes if not 

applicable, does not 

apply for Easy Pay 

notice/will default to 

zeroes

32 Last Payment 

Received Date

9(8) 317 324 MMDDYYYY

33 Last Payment 

Received 

Amount

9(8) 325 332 $$$$$$cc
Medicare Premium Bill Mailing Kits Page 64 of 92

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Field 

# Field Name Format

Start 

Position End Position Remarks

34 Template Type X(1) 333 333 R – Regular Bill 

Template (CMS500 or CMS-500ID)

E – Medicare Easy 

Pay Premium 

Template (CMS20143 or CMS20143ID: This Is 

Not A Bill)

35 Estate Bill 

Switch

X(1) 334 334 Y – Estate Bill

N – not an Estate 

Bill

36 Language 

Preference 

Code

X(1) 335 335 E – English

S – Spanish

37 Media 

Preference 

Code

X(1) 336 336 PMC Contractor:

Space – Regular 

Print 

H – Regular Print

L – Large Print

Accessible Format 

Contractor:

A – Audio Cd

B – Braille

C – CD ROM/Data 

CD

Q – Qualified 

Reader

X – Custom Format

38 Custom Format 

Description

X(50) 337 386 Format Description 

if Media Preference 

Code is X
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3561-S (01/25)

Field 

# Field Name Format

Start 

Position End Position Remarks

39 Electronic 

Medicare 

Correspondence 

Switch

X(1) 387 387 For Future Use

Y if provide CMS500 electronically

N otherwise

40 Filler X(313) 388 700 Spaces – for future 

use

 
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3561-S (01/25)

TABLE 2: FORM TEMPLATE CONTROL TABLE 

TABLE 3: PAST PREMIUM DUE DETAILS (STATIC VARIABLE) 

Field Value Description Font Size/Print Type

21 0000000 DO NOT DISPLAY

Past Premium Due

in Summary of Charges 

section

N/A

21 Not equal 

00000000

DISPLAY

Past Premium Due

in Summary of Charges 

section

Fields 21 thru 27 

“Past Premium Due” language:

Standard: Myriad Pro Bold - 10 pt 

Large Print: Helvetica Neue LT Std - 18 

pt 

Fields 21 thru 26

Standard: Myriad Pro Regular - 10 pt 

Large Print: Helvetica Neue LT Std - 18 

pt 

Field 27

Standard: Myriad Pro Bold - 10 pt 

 

Field # Value Form Template 

34 R Regular Bill Template (CMS-500 or CMS-500ID)

34 E Medicare Easy Pay Premium Statement Template (CMS-20143 or CMS-20143ID: THIS IS 

NOT A BILL)

36 E English

36 S Spanish

37 Space Regular font (Applicable Print & Mail Contractor)

37 H Regular font (Applicable Print & Mail Contractor)

37 L Large font (Applicable Print & Mail Contractor)

37 A Audio Cd (Applicable Print & Mail Contractor)

37 B Braille (Applicable Print & Mail Contractor)

37 C CD ROM/Data CD (Applicable Print & Mail Contractor)

37 Q Qualified Reader (Applicable Print & Mail Contractor)

37 X Custom Format/see field # 38 (Applicable Print & Mail Contractor)
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TABLE 4: TERMINATION DATES AND MESSAGE (STATIC VARIABLE) 

Field 

# 

Value Message Dates Font Size/Print 

Type

29 00000000 No Message None N/A

AND

30 00000000

AND

31 00000000

29 Not Equal

00000000

REGULAR CMS-500 and 

Large Print

English: 

DELINQUENT BILL in 

red on upper right of form

and

Coverage Termination 

Dates For Past-due 

Accounts

Your Medicare coverage will end on 

this date if we don’t get your 

payment by the due date. If your 

Medicare coverage is canceled, 

contact your local Social Security 

field office or call 1-800-772-1213. 

TTY users call 1-800-325-0778.

or 

Spanish: 

FACTURA VENCIDA in

red on upper right of form

and

Fechas de terminación de 

la cobertura para cuentas 

vencidas

Su cobertura de Medicare terminará 

en esta fecha si no recibimos su pago

para la fecha de vencimiento. Si se 

cancela su cobertura de Medicare, 

comuníquese con su oficina local del 

Seguro Social o llame al 1-800-772-

1213. Los usuarios de TTY pueden 

llamar al 1-800-325-0778.

Yes

All Dates 

with 

column headings: 

English: 

(Part A 

Termination

Part B 

Termination

Part D 

Termination) 

or 

Spanish: 

(Terminación de la Parte 

A

Terminación de la Parte 

B 

Terminación de la Parte 

D) 

Note: Termination dates 

equal to zeroes print as 

spaces

“DELINQUENT 

BILL” or 

“FACTURA 

VENCIDA”

Standard: Myria Pro 

Bold - 15 pt 

Large Print: 

Helvetica Neue LT 

Std - 20 pt 

“Coverage 

Termination Dates 

For Past-due 

Accounts” 

language:

Standard: Myriad Pro 

Bold - 13 pt 

Large Print: 

Helvetica Neue LT 

Std - 20 pt 

The Message:

Standard: Myriad Pro 

Regular - 10 pt

Large Print: 

Helvetica Neue LT 

Std - 18 pt 

Termination Date 

Column Headings:

Standard: Myriad Pro 

Bold - 10 pt 

Large Print: 

OR

30 Not Equal 

00000000

OR

31 Not Equal 

00000000 
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CONTINUED BELOW FOR 

CMS-500ID (PBID)

PBID CMS-500ID and Large 

Print

English: 

DELINQUENT BILL in 

red on upper right of form

and

Coverage Termination 

Dates For Past-due 

Accounts

Your Immunosuppressive Drug 

coverage will end on this date if we 

don’t get your payment by the due 

date. If your coverage is canceled, 

contact your local Social Security 

field office or call 1-800-772-1213. 

TTY users call 1-800-325-0778.

or 

Spanish: 

FACTURA VENCIDA in

red on upper right of form

and

Fechas de terminación de 

la cobertura para cuentas 

vencidas

Su cobertura de Medicare terminará 

en esta fecha si no recibimos su pago 

para la fecha de vencimiento. Si se 

cancela su cobertura de 

medicamentos inmunosupresores, 

comuníquese con su oficina local del 

Seguro Social o llame al 1-800-772-

1213. Los usuarios de TTY pueden 

llamar al 1-800-325-0778.

CONTINUED BELOW 

FOR CMS-500ID (PBID)

English: 

Part B 

Immunosuppressive 

Drug

Termination

Spanish: 

Terminación de 

medicamentos 

inmunosupresores

Helvetica Neue LT 

Std - 18 pt 

Fields 29 thru 31

Standard: Myriad Pro 

Regular - 10 pt 

Large Print: 

Helvetica Neue LT 

Std - 18 pt 

 
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TABLE 5: DELINQUENT BILL/ESTATE BILL (STATIC VARIABLE) 

Field # Value Message Font Size/Print Type

29 00000000

No Message

BLANK N/A AND

30 00000000

AND

31 00000000

AND

35 N

29 00000000 English:

DISPLAY

ESTATE BILL (in red on upper 

right of form)

or 

Spanish: 

Display

FACTURA DE HERENCIA (in 

upper right of form)

Standard: Myriad Pro 

Bold - 15 pt

Large Print: Helvetica 

Neue LT Std - 20 pt 

AND

30 00000000

AND

31 00000000

AND

35 Y

29 Not Equal 

00000000

English:

DISPLAY

DELINQUENT BILL (in red on 

upper right of form)

or 

Spanish: 

Display

FACTURA VENCIDA (in red

on upper right of form)

Standard: Myriad Pro 

Bold - 15 pt

Large Print: Helvetica 

Neue LT Std - 20 pt 

OR

30 Not Equal 

00000000

OR

31 Not Equal 

00000000

AND

35 N

29 Not Equal 

00000000

English:

DISPLAY

ESTATE BILL (in red on upper 

right of form)

or 

Spanish: 

Display

FACTURA DE HERENCIA (in

red on upper right of form)

Standard: Myriad Pro 

Bold - 15 pt

Large Print: Helvetica 

Neue LT Std - 20 pt

OR

30 Not Equal 

00000000

OR

31 Not Equal 

00000000

AND

35 Y
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EXHIBIT B: CMS-500 AND CMS-500ID SCAN LINE SPECS 
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EXHIBIT C: OCR SCAN LINE SPECS 
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EXHIBIT D: CMS-500 MEDICARE PREMIUM BILL, STANDARD PRINT, ENGLISH 

EXHIBIT E: CMS-500ID, STANDARD PRINT, ENGLISH 
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EXHIBIT F: CMS-20143 MEDICARE EASY PAY PREMIUM STATEMENT, STANDARD PRINT, ENGLISH 

EXHIBIT G: CMS-20143ID, STANDARD PRINT, ENGLISH 
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EXHIBIT H: CMS-500 MEDICARE PREMIUM BILL, LARGE PRINT, ENGLISH 
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EXHIBIT I: 8-1/2 × 14” STUFFER, STANDARD PRINT, 2 INK COLORS 
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EXHIBIT J: 11 × 8-1/2” STUFFER, LARGE PRINT, ENGLISH 
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EXHIBIT K: 8-1/2 × 11” STUFFER, STANDARD PRINT, SINGLE INK 

EXHIBIT L: 8-1/2 × 11” STUFFER, LARGE PRINT, SINGLE INK 

NOTE: Exhibits D through L are a sampling of CMS Forms and Bill Stuffers ordered on this contract. Not all 

CMS Forms and Bill Stuffers are represented with an Exhibit.