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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(12)
New
500
250
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(15)
New
100
300
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(2)through(d)(4)
New
67723
203169
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(6)
New
250
750
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(9)
New
250
750
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - Initial Enrollment Application
New
9000
54000
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - Reporting Changes of Enrollment Information
New
34800
17400
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - Revalidation of Enrollment Information
New
36667
55001
0
Form
CMS-855S
CMS-855S
Total burden requested under this ICR:
149290
331620
0
To view an IC, click on IC Title