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DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF MEDICARE HEARINGS AND APPEALS Addendum to Agreement to Participate in Settlement Conference Facilitation Use this form if you require additional signature

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What is addendum to agreement to?

Addendum to agreement is a document that modifies or adds specific terms or conditions to an existing agreement.

Who is required to file addendum to agreement to?

Any party involved in the agreement who wishes to make changes to the original terms must file an addendum.

How to fill out addendum to agreement to?

To fill out an addendum to an agreement, specify the original agreement, clearly state the changes being made, and have all parties involved sign and date the document.

What is the purpose of addendum to agreement to?

The purpose of an addendum to an agreement is to make changes or additions to the original terms without having to create an entirely new agreement.

What information must be reported on addendum to agreement to?

The addendum must include details of the original agreement, the specific changes being made, and must be signed and dated by all parties involved.

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