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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)
Removed
0
0
0
Form and Instruction
CMS-855S
Medicare Enrollment Application
Change of Enrollment Information
Modified
14117
14117
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
6716
26864
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
2508
10032
0
Form and Instruction
CMS-855S
Medicare Enrollment Application
Revalidation of enrollment information
Modified
8099
16198
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
1350
675
0
Form and Instruction
CM-855S
Medicare Enrollment Application
Total burden requested under this ICR:
32790
67886
0
To view an IC, click on IC Title