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
Enrollment of MA Providers, Suppliers, and First-Tier, Downstream, and Related Entities (FDRs) (section 422.222)	Modified	10666	42664	0	Form and Instruction	CMS-855S
	Modified	10666	42664	0	Form and Instruction	CMS-855S
Initial Enrollment	Modified	10323	20648	0	Form and Instruction	CMS-855S
Initial Enrollment	Modified	10323	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:		111262	96677	0
To view an IC, click on IC Title