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WEDI CMS-0057-F Testing Directory Questionnaire for Organizations

Introduction
Please complete the following questions and provide as much information as possible. Information provided in this questionnaire will be posted publicly as part of WEDI’s CMS-0057-F Testing Directory. Information can be updated by submitters as frequently as necessary.

If you have any questions about this submission form, please submit them to apoole@wedi.org.
1.Date Submitted/Updated (Enter the date of this submission.)(Required.)
Date / Time
2.Submission Type (Identify if this is your initial submission or update to a previous submission.)(Required.)
3.Please provide a name and contact phone number or email address for any questions WEDI may have about your entry. This information will be used for WEDI internal purposes only and will not be shared.(Required.)
4.Type of Organization (Identify your type of organization.)(Required.)
5.Type of Organization interested in testing with ((Identify the type of organization you are interested in testing with. Select all that apply.)(Required.)
6.Organization Name (Enter the name of your organization.)(Required.)
7.Contact Name (Enter the name of your contact person. This can be an individual or general contact, e.g., help desk, IT support, etc.)(Required.)
8.Contact Phone and/or Email (Enter your contact phone number or email address. This can be a voicemail box or email box.)(Required.)
9.Organization URL to dedicated CMS-0057-F testing page (Enter the URL for your organization’s website for CMS-0057-F testing resources.)(Required.)