View Information Collection (IC)

View Information Collection (IC)

Medicare Enrollment Applications
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 855B Medicare Enrollment Application - Clinics/group Practices and Certain Other Suppliers CMS-855B.pdf Yes No Fillable Fileable
Form and Instruction 855A Medicare Enrollment Application - Institutional Providers CMS-855A.pdf No No Fillable Fileable
Form and Instruction 855I Medicare Enrollment Application -Physicians and Non-Physician Practitioners CMS-855I.pdf Yes No Fillable Fileable
Form and Instruction 855R Reassignment of Medicare Benefits CMS-855R.pdf Yes No Fillable Fileable

Health Health Care Services

 

1,740,800 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,740,800 0 0 1,311,350 429,450 0
Annual IC Time Burden (Hours) 290,609 0 0 -565,786 856,395 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.