Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Medicare Enrollment Applications Modified 1740800 290609 0 Form and Instruction 855B Medicare Enrollment Application - Clinics/group Practices and Certain Other Suppliers
Form and Instruction 855A Medicare Enrollment Application - Institutional Providers
Form and Instruction 855I Medicare Enrollment Application -Physicians and Non-Physician Practitioners
Form and Instruction 855R Reassignment of Medicare Benefits
Total burden requested under this ICR: 1740800 290609 0  
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