Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-0685
ICR Reference No:
201105-0938-012
Status:
Historical Active
Previous ICR Reference No:
200809-0938-014
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Medicare Enrollment Application
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
07/01/2011
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/25/2011
Terms of Clearance:
Approved for one year since CMS has advised that this collection will be revised in January. The approval currently extends only to the mode of collection (paper based form) contained in this request.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2012
36 Months From Approved
01/31/2012
Responses
429,450
0
400,000
Time Burden (Hours)
856,395
0
785,702
Cost Burden (Dollars)
0
0
0
Abstract:
CMS is revising the CMS-855 Medicare Enrollment Applications Package (OMB No. 0938-0685) to remove the CMS-855S application from its collection. CMS has found that the regulations governing the standards required of suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) are revised and increased more frequently than the other provider types reimbursed by Medicare. The ability to revise the CMS 855S separately from the other CMS 855 enrollment applications will lessen the burden on both CMS and OMB as well as the public during the Federal Register notice period, as only one subset of suppliers will be effected by CMS 855S revisions.
Authorizing Statute(s):
PL:
Pub.L. 104 - 134 31001(I)
Name of Law: Debt Collection Improvement Act of 1996
US Code:
42 USC 1395f
Name of Law: Conditions of and Limitations on Payment for Services
PL:
Pub.L. 105 - 33 4313
Name of Law: Provision of certain identification numbers
US Code:
42 USC 1395g
Name of Law: Payment to Providers of Services
US Code:
42 USC 1395l
Name of Law: Payment of Benefits
US Code:
42 USC 1395u
Name of Law: Provisions related to the Administration of Part B
US Code:
42 USC 1395m
Name of Law: SPECIAL PAYMENT RULES FOR PARTICULAR ITEMS AND SERVICES
US Code:
42 USC 1395cc
Name of Law: AGREEMENTS WITH PROVIDERS OF SERVICES; ENROLLMENT PROCESSES
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
76 FR 13415
03/11/2011
30-day Notice:
Federal Register Citation:
Citation Date:
76 FR 29247
05/20/2011
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Medicare Enrollment Application
CMS-855B, CMS-855(I), CMS-855(R), CMS-855A
Medicare Enrollment Application - Clinics/group Practices and Certain Other Suppliers
,
Medicare Enrollment Application -Physicians and Non-Physician Practitioners
,
Medicare Enrollment Application -REASSIGNMENT OF MEDICARE BENEFITS
,
Medicare Enrollment Application - Institutional Providers
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
429,450
400,000
0
29,450
0
0
Annual Time Burden (Hours)
856,395
785,702
0
70,693
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
The currently approved total annual hour burden for respondents to the CMS-855A, CMS-855B, CMS-855I and CMS-855R is 785,702.3 hours. As outlined above, we estimate that the changes described in section 12 of this document will add 70,693 hours to this burden at a cost of $7,744,860. Therefore, the total hour burden for the respondents to the CMS-855A, CMS-855B, CMS-855I and CMS-855R is 856,395.3 hours. The group/clinic and individual burden has decreased due to the removal of a previously proposed supplier attachment. However, the overall burden hour estimate has increased slightly due to additional role-specific ownership and managerial control data collection for institutional providers.
Annual Cost to Federal Government:
$0
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Yes
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
William Parham 4107864669
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
05/25/2011
An official website of the United States government
The .gov means it's official.
The site is secure.
