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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Adding Information (New Business Data)
Modified
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
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
Modified
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
Modified
7
4
0
Form and Instruction
CM-855S
Medicare Enrollment Application
Total burden requested under this ICR:
45115
88491
0
To view an IC, click on IC Title