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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Change of Enrollment Information
New
35300
17650
0
Form and Instruction
CMS-855(S)
Medicare Durable Medical Equipment Supplier Enrollment Application
Initial Enrollment
New
9000
81000
0
Form and Instruction
CMS-855(S)
Medicare Durable Medical Equipment Supplier Enrollment Application
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(12)
Removed
0
0
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(15)
Removed
0
0
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(2)through(d)(4)
Removed
0
0
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(6)
Removed
0
0
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(9)
Removed
0
0
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - Initial Enrollment Application
Removed
0
0
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - Reporting Changes of Enrollment Information
Removed
0
0
0
Form
CMS-855S
CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - Revalidation of Enrollment Information
Removed
0
0
0
Form
CMS-855S
CMS-855S
Revalidation of enrollment information,
New
36667
55001
0
Form and Instruction
CMS-855(S)
Medicare Durable Medical Equipment Supplier Enrollment Application
Surety Bond Compliance
New
59323
177969
0
Form and Instruction
CMS-855(S)
Medicare Durable Medical Equipment Supplier Enrollment Application
Total burden requested under this ICR:
140290
331620
0
To view an IC, click on IC Title