Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Change of Enrollment Information New 35300 17650 0 Form and Instruction CMS-855(S)
Initial Enrollment New 9000 81000 0 Form and Instruction CMS-855(S)
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(12) Removed 0 0 0 Form CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(15) Removed 0 0 0 Form CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(2)through(d)(4) Removed 0 0 0 Form CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(6) Removed 0 0 0 Form CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - 424.57(d)(9) Removed 0 0 0 Form CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - Initial Enrollment Application Removed 0 0 0 Form CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - Reporting Changes of Enrollment Information Removed 0 0 0 Form CMS-855S
Medicare Enrollment Application (Form 855S) - Part II - Revalidation of Enrollment Information Removed 0 0 0 Form CMS-855S
Revalidation of enrollment information, New 36667 55001 0 Form and Instruction CMS-855(S)
Surety Bond Compliance New 59323 177969 0 Form and Instruction CMS-855(S)
Total burden requested under this ICR: 140290 331620 0  
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