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: 201803-0938-002
Status: Historical Active	Previous ICR Reference No: 201712-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No: CPI
Title: Medicare Enrollment Applications (CMS-855A, -855B, and -855I)
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: 12/03/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/19/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	36 Months From Approved	08/31/2019
Responses	1,733,400	0	1,786,732
Time Burden (Hours)	289,393	0	513,435
Cost Burden (Dollars)	0	0	0

Authorizing Statute(s): PL: Pub.L. 111 - 148 6001 Name of Law: Affordable Care Act
   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
   PL: Pub.L. 104 - 134 31001(I) Name of Law: Debt Collection Improvement Act of 1996
   US Code: 42 USC 1395g Name of Law: Payment to Providers of Services
   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
   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

Citations for New Statutory Requirements: None

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	1,733,400	1,786,732	-53,332
Annual Time Burden (Hours)	289,393	513,435	-224,042
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: To understand the following changes we note that the March 6, 2017, OMB approval set out 1,786,732 responses and 513,435 which should have been 1,853,400 responses and 715,393 hours. That iteration had accounted for 53,332 unenrolled Medicare Advantage providers. The correct number should have been 120,000 providers (6,000 CMS-855A + 24,000 CMS-855B + 90,000 CMS-855I) which would then translate to 1,853,400 responses and 715,393 hours. CMS-4182-F rescinds the enrollment requirements in 42 CFR 422.222, for all individuals or entities who provide health care items or services to a Medicare enrollee who receives his or her Medicare benefit through a Medicare Advantage organization. Therefore, all references to Medicare Advantage has been eliminated from this PRA package. This iteration reduces burden by -224,042 hours.

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. 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: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov