Welcome to PECOS E-Signature Application

Remote Authentication Page

You have been directed to this site in order to electronically sign certain required documents related to Medicare enrollment application recently submitted on your behalf.

WARNING: If you believe you have been directed to this site by mistake, please close this page immediately. Only authorized users have the right to access this site. By accessing and using this system you expressly consent to system monitoring. Any misuse will be documented as evidence of possible criminal activity and reported to the appropriate law enforcement officials.

Verify Your Identity and Validate Your Application Record

Enter the required Identity information:

* First Name


* Last Name


* Date of Birth

Expected Format: MM/DD/Y Y Y Y

* SSN

No Format Required

Enter the email address and PIN you received in the PECOS emails:

* Email Address


* PIN

If your PIN is lost or expired, click here to generate a new one.