Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Adding Information (New Business Data) New 1242 1242 0 Form and Instruction CMS-855S Medicare Enrollment Application
Change of Enrollment Information Modified 12105 12105 0 Form and Instruction CMS-855(S) Medicare Durable Medical Equipment Supplier Enrollment Application
Form and Instruction CMS-855-S Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers
Enrollment of MA Providers, Suppliers, and First-Tier, Downstream, and Related Entities (FDRs) (section 422.222) Removed 0 0 0 Form and Instruction CMS-855S Medicare Durable Medical Equipment Supplier Enrollment Application
Form and Instruction CMS-855S Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers
Initial Enrollment Modified 3429 13716 0 Form and Instruction CMS-855S Medicare Durable Medical Equipment Supplier Enrollment Application
Form and Instruction CMS-855-S Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers
Reactivation - Medicare Enrollment Application New 2376 9512 0 Form and Instruction CMS-855S Medicare Enrollment Application
Revalidation of enrollment information Modified 25956 51912 0 Form and Instruction CMS-855S Medicare Durable Medical Equipment Supplier Enrollment Application
Form and Instruction CMS-855-S Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers
Voluntary Withdrawing from Medicare New 7 4 0 Form and Instruction CM-855S Medicare Enrollment Application
Total burden requested under this ICR: 45115 88491 0  
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