Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Change of Registration Information Modified 11200 5600 0 Form and Instruction CMS-855O Medicare Registration Application
Initial Application Modified 448000 224000 0 Form and Instruction CMS-855O Medicare Registration Application
Reporting Voluntary Withdrawal of Registration Information Modified 56000 14000 0 Form and Instruction CMS-855O Medicare Registration Application
Total burden requested under this ICR: 515200 243600 0  
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