Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Change of Registration Information Modified 8000 4000 0 Form and Instruction CMS-855O Medicare Registration Application
Other-Screen Shots
Initial Application Modified 40000 20000 0 Form and Instruction CMS-855O Medicare Registration Application
Other-Screen Shots
Reporting Voluntary Withdrawal of Registration Information New 500 125 0 Form and Instruction CMS-855O Medicare Registration Application
Other-Screen Shots
Total burden requested under this ICR: 48500 24125 0  
To view an IC, click on IC Title