Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.
Change of Enrollment Information	Unchanged	68681	17171	0	Form and Instruction	CMS-855(S)
Change of Enrollment Information	Unchanged	68681	17171	0	Form and Instruction	CMS-855-S
Enrollment of MA Providers, Suppliers, and First-Tier, Downstream, and Related Entities (FDRs) (section 422.222)	New	10666	63996	0	Form and Instruction	CMS-855S
	New	10666	63996	0	Form and Instruction	CMS-855S
Initial Enrollment	Unchanged	5162	20648	0	Form and Instruction	CMS-855S
Initial Enrollment	Unchanged	5162	20648	0	Form and Instruction	CMS-855-S
Revalidation of enrollment information	Unchanged	21592	16194	0	Form and Instruction	CMS-855S
Revalidation of enrollment information	Unchanged	21592	16194	0	Form and Instruction	CMS-855-S
Total burden requested under this ICR:		106101	118009	0
To view an IC, click on IC Title