Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.
Change of Enrollment Information	Modified	68681	17171	0	Form and Instruction	CMS-855(S)
Change of Enrollment Information	Modified	68681	17171	0	Form and Instruction	CMS-855-S
Initial Enrollment	Modified	5162	20648	0	Form and Instruction	CMS-855S
Initial Enrollment	Modified	5162	20648	0	Form and Instruction	CMS-855-S
Revalidation of enrollment information	Modified	21592	16194	0	Form and Instruction	CMS-855S
Revalidation of enrollment information	Modified	21592	16194	0	Form and Instruction	CMS-855-S
Total burden requested under this ICR:		95435	54013	0
To view an IC, click on IC Title

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.